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Please Fill out this form in it's entirety! You/your child are not registered until Liability Waiver and Code Of Conduct Forms are signed

Student First Name

Student Last Name

Student Date of birth

Month

Day

Year

Class You Are Trying

Parent/Guardian First and Last Name (if adult just put N/A)

Parent/Guardian/Adult Student Email

Parent/Guardian/Adult Student Preferred Phone #

Does your child have any special needs, diagnoses, or support needs we should know about to best support them in class? Please be as detailed as you’d like — if none, just write N/A.

I declare that I have read and acknowledge the IMAGINE PERFORMING ARTS CENTER PARTICIPATION AGREEMENT, LIABILITY WAIVER, AND POLICY ACKNOWLEDGEMENT,

https://www.imagineperformingartscenter.org/liabilitywaiver

By signing, I acknowledge that I have read, understood, and agree to all the terms and conditions stated in this agreement.

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I declare that I have read and acknowledge the IMAGINE PERFORMING ARTS CENTER STUDENT CODE OF CONDUCT

https://www.imagineperformingartscenter.org/codeofconduct

By signing, I confirm that I have read, understood, and agree to the student code of conduct, and I am aware of the consequences of not adhering to it.

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Emergency Contact Name

Emergency Contact Phone

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