Registration Cart
(707) 462-9370 • 145 E. Church St., Ukiah CA 95482 •
info@spaceperformingarts.org
SPACE Classes
-- Register Online on our Secure Server
Registration Cart
Please provide the following information for the
FIRST STUDENT you are registering:
[
*
] indicates required
*
Choose one:
New Student
Continuing Student
Please be sure to select the appropriate registration fee below.
STUDENT INFORMATION
*
Student's Name:
Street Address:
City, Zip:
Home Phone:
Birthdate
(M/D/Y):
Age:
School:
Grade:
REGISTERING PARENT/GUARDIAN INFORMATION
Par./Guard. Name:
Address:
check if address is
Same as Student's
then continue to "Work Phone"
Street Address:
City, Zip:
Home Phone:
Work Phone
EMERGENCY CONTACT OTHER THAN PARENT
Emergency Name:
Relationship:
Phone:
ADDITIONAL INFORMATION
Please tell us of any information about your child that will help insure a safe and succesful experience:
REGISTRATION FEES
*
Select the appropriate registration fee:
Registering this student for
ONE class: $15
Registering this student for
TWO classes: $10
Registering this student for
THREE classes: $5
Registering this student for
FOUR or more
classes: $0
IMPORTANT
RELEASE OF LIABILITY INFORMATION
: When we receive your online registration, we will e-mail our "Release from Liability" form to you for each student you are registering. Your child will be
required
to bring this signed form to the first class. Or you may come to the SPACE office prior to the first class and request a "Release from Liability" form to be signed.
