Crozet Arts Registration Form

To register:

  • Please read the "Policies"
  • Complete this form, and click the checkboxes as a signature, below as indicated.
  • Please complete a separate registration form for each student.
  • To complete registration, CLICK the Submit Registration button at the bottom of the form. You will be taken to a page to enroll in a class and choose payment method.
Student Information:
Student Name:
     
Birthdate:
(if age 18 or under)
     
Grade (Fall 2016):
(if age 18 or under)
     
Parent’s or Adult Student’s Contact Information:
Name:
     
Email:
     
Telephone:
     
Emergency Phone:
     
Liability Waiver and Medical
Please check this box to indicate your agreement:

By checking this box you fulfill your Crozet Arts registration & Liability Waivers, Photography Release, and Permission for ER care for Crozet Arts for September 2016 - August 2017 for all Class-Card Purchases and Dropins.

Please complete a separate registration form for each student once per year (September 2016 - August 2017).

   
Please check this box to indicate your agreement:
I signify that I have read and completed this registration form. I agree to pay the total tuition due and agree to the terms of the liability and medical waivers and photography release and give permission for emergency medical treatment as stated on this form.
   
Please check this box to indicate your agreement:

Liability & Medical Waivers, Photography Release, Permission for Emergency Care:
I hereby attest that my child (or, if 18 or older, I myself) is (am) physically able to participate in the above classes at Crozet Arts. I hereby waive and release all claims, liabilities, actions, damages, costs or expenses of any kind for injuries or losses my child (or, if 18 or older, I myself) may incur while participating in classes at Crozet Arts, now or in the future. I agree to indemnify and hold harmless Crozet Arts, its directors, instructors, staff and associates from and against any and all claims, liabilities, actions, damages, costs or expenses of any kind for injuries or losses my child (or, if 18 or older, I myself) may incur while participating in classes at Crozet Arts, now or in the future. In case of emergency while at Crozet Arts, I give permission for my child (or, if 18 or older, I myself) to receive emergency medical treatment.

I signify my agreement with these liability & medical waivers, and grant permission for photographs of my child (or, if 18 or older, I myself) to be used for promotional purposes without financial compensation.

   
Please briefly describe any medical or other issues the student has of which the instructor(s) should be aware:    
 

NOTE: You will have the option to pay online or by check after you Submit your Registration.