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.
Date

MonthDayYear
SCHOLARSHIPS AVAILABLE for adults 65 or older residing in Madison County and for kids with a financial need. 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. NOTE: Limited to one class/workshop per family per session.
I am an adult 65 or older residing in Madison County requesting help to cover my class fees.*

NOYES
I am registering a minor child and request help to cover class fees.*

NOYES
To see what classes are available, click here.
Class Title (pick one or more)*

JUL - K Brown - Exploring ColorJUL - K Brown - Exploring Printmaking & CollageJUL - K Brown - Exploring SculptureJUL - K Brown - Exploring Your Dream HomeAUG - D Mihill - Theater Workshop for Ages 8-12AUG - D Mihill - Theater Workshop for Ages 13-16JUN - J Talbot - First Friday Drum Circle (individuals)JUN - J Talbot - First Friday Drum Circle (families)JUL - J Talbot - First Friday Drum Circle (individuals)JUL - J Talbot - First Friday Drum Circle (families)JUL - L Yardley - Sketchbook ProjectJUL - J Levins - Watercolor PortraitsAUG - J Talbot - First Friday Drum Circle (individuals)AUG - J Talbot - First Friday Drum Circle (families)AUG - M Brezicky - Printmaking Techniques With 20th Century TechAUG - J Levins - Put a Barn in it
Name:*
Name of workshop participant
Is the participant a minor?*

NOYES
Name of Parent/Guardian:*
Age:*
Pick up arrangements - student will:*

be picked up by parent/guardian stated abovewalk 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

CityState

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.*

YESNO
PLEASE NOTE: Social distancing and wearing masks isan appreciated choice.
Vaccinated for COVID19*

YESNO
Date of last COVID19 vaccination?

MonthDayYear
Date
Special requirements, message to CazArts or OTHER:

125 words maximum0/125
How did you hear about CazArts classes? Check all that apply.*

WebsitePosterFacebookEmail/NewsletterInstagramAdvertisementNextdoorNewspaperFriend or family
Would you like to become a CazArts member?
If you are planning to register multiple participants, please complete and submit a registration form to register each participant. You will be able to pay for multiple registered participants and/or classes all at once.
Should be Empty: