CazArts Class Registration Form

CazArts Class Registration Form

This form collects information required and requested for registrants of CazArts classes. PLEASE NOTE: Answers to the optional questions will help us to serve you better, so answer all you can.
To see what classes are available, click here.
Date

Month Day Year
Class Title *

NOV18 - J Talbot - Drumming Circle for All (individuals) NOV18 - J Talbot - Drumming Circle for All (families)
Name: *
Name of workshop participant
Is the participant a minor? *

NO YES
Name of Parent/Guardian: *
Age: *
Pick up arrangements - student will: *

be picked up by parent/guardian stated above walk home
Contact Phone Number: *
cell or landline
Emergency Contact Phone Number: *
cell or landline
Contact Email Address: *
We will send additional class details, payment and other notifications to this address. If you do not have an email address, please provide your address below and type "no email" above.
Participant's email address (if different from above:
Helpful, but optional
Participant's phone number:
Helpful, but optional, cell or landline
Address:

Street Address

City State

Zip Code
LIKENESS AGREEMENT – By selecting “YES”, I allow CazArts to use my likeness from photos and videos taken in the above-noted class, on promotional materials in connection with CazArts. *

YES NO
For seniors (65 or older) with a financial need and residing in Madison County, CazArts can cover the class fees thanks to a generous donor. If you would like to access this assistance, select "YES" below. If funds are still available, you will be notified by CazArts.
I am a senior citizen residing in Madison County requesting help to cover class fees. *

NO YES
PLEASE NOTE: For everyone's health and safety, we are currently following these Covid policies:

If you are vaccinated, masks are appreciated, but not required. If you are not vaccinated, masks are required.
Vaccinated for COVID19 *

YES NO
Date of last COVID19 vaccination?

Month Day Year
Date
Special requirements, message to CazArts or OTHER:

125 words maximum 0/125
Would you like to become a CazArts member?
Should be Empty: