Adult/Child Class Registration

120 E. Garfield Del Rio, TX 78840

830-775-0888                  DelRioArts.com

Name of Student:_________________________________________Age:_________

Name of Parent or legal guardian if student is under 18:__________________________

Address:  _________________________________________________________    

City:  _______________________________ ST:  _________ Zip: _______________

Phone #:  ________________________ Alternate Phone: _____________________

Email:  _________________________________________________________________

In Case of Emergency Local Contact (other than parent listed above:

Name:  ________________________________ Phone:  ______________________

Selected Classes:

Class:  _________________________________________ Tuition: $____________

Class:  __________________________________________ Tuition: $____________

Class:  __________________________________________ Tuition: $____________

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.
                I hereby 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. 

Student of Legal Guardian:  _______________________________Date:  __________