Registration Form

Del Rio Council for the Arts Class Registration Form
120 E. Garfield Del Rio, TX 78840
Name of Student *
Age *
Name of Parent or legal guardian if student is under 18
Address *
City *
ST *
Zip *
Phone # *

Area Code Phone Number
Alternate Phone

Area Code Phone Number
Email *
example@example.com
Name of emergency local contact (other than parent listed above) *
Phone *

Area Code Phone Number
Class Registering For: *
Class Registering For:
Class Registering For:
All payments are due in full at time of registration. You may pay by cash. check or major credit card. Cancellation of a class may occur due to insufficient enrollment; you will be notified by phone. Full refunds are only given for classes cancelled by the Firehouse. If you must withdraw from a class prior to the first class meeting. you will be refunded your tuition less 30% Refunds are not given after the first class meeting. Ihereby give my consent to take instruction from the Del Rio Council for the Arts and agree to hold the DRCA or instructors harmless from any injuries arising out of said instruction, other than injuries caused by gross negligence of the DRCA. In the event of an accident and/or illness, I authorize the DRCA or one of its instructors or employees to seek medical attention and I will assume all expenses incurred. I agree to grant the DRCA unlimited usage of all photographs taken during class and performance time.
Signature of Student or Legal Guardian

Clear
Date *

Month Day Year
Date
Should be Empty:

Del Rio Council for the Arts Class Registration Form