Donguri Kai Registration

Donguri Kai Registration Form

2024 Youth Advanced Online
Parent Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Student's Name*

First NameLast Name
Student's Birthday

MonthDayYear
Date
Are you a JASC member?*

Yes, I am a JASC memberNo, I am not a JASC Member
Consider buying a family membership today to help support JASC and lower your total class fee expenses. A family membership is $115 (donate online HERE). When registering for the entire year of Fall, Winter, and Spring classes, your membership discount saves $250 which more than covers the cost of your membership.
Youth Advanced Class Online (Fridays 4:30 pm to 5:30 pm) on Zoom

Member - $150 (code:d1yaofm)Non-Member - $210 (code:d1yaofnm)

Class Fees Total
Class Fee Sum Total
Your Class Fee Total

prevnext( X )
USDDescription
Photo Release Waiver
I hereby authorize Japanese American Service Committee ("JASC") and its representatives to use, print, publish, or display a picture and/or use my name for public relations or other purposes to benefit the JASC and its program. I have read and understand this consent form.

I hereby grant and authorize JASC to make use of photos involving the child listed above in this registration form. I understand that I can withdraw my consent at any time.I do not allow the use of photos of the child listed above in this registration form.
Authorized Representative's Name

First NameLast Name
Authorized Representative's relationship to child being registered
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Fill in your payment information below. Click the green Submit button to complete your registration.

You should receive a confirmation from noreply@jotforms.com with a copy of your registration information.

If you don't receive a confirmation email, please contact Jenn at the JASC (jtrautvetter@jasc-chicago.org)

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Donguri Kai Registration Form