Homeschool Club Registration

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

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.

Siblings you would like to register and their ages!

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