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Registration Form-Shekinah Arts!

~Print & Take Form to Kent County Parks & Recreation to Complete Registration~

 

REGISTRATION FORM (One Form Per Person)

 

Date                                                                                       

New Student                                        

 Returning Student

 

NAME                                                                                     

Date Of Birth:                                                                        

AGE:                                                                                       

 

ENROLLING IN CLASS(S) (Check All That Apply):

□Kidz Praize! (7-9)                                    □ Jr. Praize & Spiritual Movement (7-9)           □ Holy Hip Hop (10&up)

□Spiritual Movement (10&up)  □Spiritual Movement (Adults)  □Other:                                                                                          

 

PARENT/GUARDIAN (If Under 18)                                                                                                                                                  

 

HOME ADDRESS                                                                                                                                                               

HOME PHONE                                                                     WORK PHONE:                                                  

 

E-MAIL:                                                                                  CELL PHONE:                                                                                    

 

EMERGENCY CONTACTS (List two that are available during your scheduled class time).

 

NAME:                                                                                   NUMBER                                                                             

 

NAME:                                                                                  NUMBER                                                                             

Special circumstances, needs or physical challenges? Please Explain.  This will better equip us to service you or your child so that they can get the maximum experience:

 

 

 

I Agree and Understand The Following: (Initial Each):

_____1. Shekinah Arts!  is not responsible for the supervision of the participant(s) either before or after the participants’ regularly scheduled class time.

_____2.  Shekinah Arts! reserves the right to photograph and videotape programs and participants for training, advertising, promotional activities, and any other lawful purposes.  If I do not want my or my child’s photo used, I understand that it is my responsibility to notify Shekinah Arts! in writing.

_____3.  I am aware of and voluntarily accept all risks that my child or I may be involved with in participation of activities with Shekinah Arts! and will not hold Shekinah Arts!, its workers or volunteers responsible for bodily injury or loss of any kind. It is understood and agreed that Shekinah Arts!, its employees and agents, cannot be responsible for any aggravation or injury caused as a result of a pre-existing physical defect; including but not limited to, allergies.  Shekinah Arts! will be notified of any such defects or sensitivities in writing prior to enrolling in this program.

_____4.   Tuition is due at time of registration class.  Enrollment will be considered complete once a student has paid tuition and attended class. Credits or refunds will not be issued due to missed classes. A $25 charge will be applied to all returned checks.

 

I have read and understand the Shekinah Arts! policies.

 

                                                                                                                                                                               

Student or Parent/Guardian Signature                                                                            DATE

PAYMENT INFORMATION

 

Registration Form & Payment can be completed at or mailed to KCPR, P.O. Box 67, Worton, MD 21678. Please make checks or money orders payable to: “Tamika Sudler-Shekinah Arts.”

**Shekinah Arts! Is an independent agency and is NOT affiliated with KCPR

 

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------------------------------------------------------------OFFICE USE ONLY----------------------------------------------------------------------

 

Date Reg. Form Received:                                   # of Classes Enrolled:                        Date Tuition Paid:                            

 

~Print & Take Form to Kent County Parks & Recreation to Complete Registration~

Tamika Johnson
Leading Lady Enterprises
P.O. Box 35, Worton, MD 21678
 
Website Created and Maintained by Tamika Johnson
 
All content of this Internet site (including design; information; audio; video; photographs and graphics elements) are copyrighted by Tamika Johnson/Leading Lady Enterprises. Information herein may not be reproduced, transmitted, rebroadcast, published, rewritten or distributed in any form without the expressed written consent of Tamika Johnson/Leading Lady Enterprises