Guadalupe Academy Online Form

Guadalupe Academy Registration Form

Student Name *

First

Last

Date of Birth *

Gender

Age *

Grade

Parent Name (if applicable)

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

School Attending

School District

City Council District

Number in Household

How did you hear about Guadalupe Academy classes?

What class/es is student taking?

Household Income

Signature

FOR THE STUDENTS UNDER THE AGE OF 18 I hereby give my son/daughter permission to attend Guadalupe Academy classes. In case of emergency during class time or field trips, I understand that proper medical aid will be sought and I will be responsible for all charges accrued. I will not hold the instructor, the Guadalupe Cultural Arts Center, or any other partnership responsible. GCAC occasionally takes photographs or videos of classes or recitals. My signature is also a photographic release for my son/daughter.

Signature

FOR THE STUDENTS UNDER THE AGE OF 18 In case of emergency during class time or field trips, I understand that proper medical aid will be sought and I will be responsible for all charges accrued. I will not hold the instructor, the Guadalupe Cultural Arts Center, or any other partnership responsible. GCAC occasionally takes photographs or videos of classes or recitals. My signature is also a photographic release for my son/daughter.

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