Beck Center for the Arts - Classes

Fall 2008 Online Registration Form
Use this form to request your class. Beck Center will contact you before the end of the next business day with a confirmation and to take your credit card order. You may also use the print/mail form [pdf].

Student's Name:
School:
Date of Birth:	MM DD YYYY
Age:
Gender:	Male Female
Student Status:	New Student Returning Student
Address:
Apt. Number:
City:
State:
Zip:
E-Mail:
Responsible Party (for Payment):
Phone (Home):
(Work/Cell):
Why did you choose Beck Center for this class?
How did you hear about classes at Beck Center?	Advertisement Catalog Friend Library School Employee Website Other- please specify
Are you familiar with our Professional Theater?	Yes No If no, and you would like to receive information check here

CLASSES

Class	Day	Time	Session	Tuition	Start Date

PRIVATE MUSIC LESSONS

Instrument	Instructor	Day	Time	Length(mins.)	Wks.	Tuition	Start Date

ANNUAL PAYMENT SUMMARY
Registration Fee $35 Individual; $70 Family:	$ Non-refundable. See registration information.
Tuition:	$
Other Fee (if applicable):	$
Donation (Your tax-deductible donation will help support the programs of the Beck Center for the Arts, a not-for-profit organization):	$
Total Payment Due:	$

Please check if you DO NOT want your child photographed or videotaped for any Beck Center or media use. If this line is not checked, you are agreeing to allow any photos or video obtained of your child while in classes at the Beck Center to be used in publication by the Beck Center or other media.

I UNDERSTAND THAT SUBMITTING THIS FORM IMPLIES AGREEMENT TO, AND OBSERVANCE OF, THE RULES AND REGULATIONS OF BECK CENTER AS PUT FORTH IN REGISTRATION POLICIES AND THIS REGISTRATION FORM. IF I/MY CHILD REQUIRE(S) EMERGENCY MEDICAL TREATMENT WHILE UNDER THE JURISDICTION OF THE BECK CENTER FOR THE ARTS, I AUTHORIZE THE BECK CENTER TO CONTACT EMERGENCY MEDICAL SERVICES AND TO PERFORM TREATMENT AS DEEMED NECESSARY.

Beck Center Registrar 17801 Detroit Avenue Lakewood, Ohio 44107