Registration Form
NAME : HOME PHONE : ( ) WORK PHONE : ( ) CELL : ( ) STREET ADDRESS : CITY : STATE : ZIP :
EMAIL ADDRESS :
By giving us your email we can notify you of program changes , cancellations , and new programs that will interest you . Your email address will not be shared with any other organization . You will not be spammed .
EMERGENCY CONTACT : EMERGENCY CONTACT PHONE : ( )
o Check this box to opt out of program updates via email .
CLASS # PARTICIPANT NAME ( FIRST , LAST ) CLASS NAME COST
SUBTOTAL
PAYMENT INFORMATION UCARE ID #
UCARE DISCOUNT
Register now , pay later — see page 14
TOTAL COST o CHECK ( Payable to “ District 622 ”— will be handled as a one-time electronic fund transfer or draft ) o VISA o MASTERCARD
CARD NUMBER : ___ ___ ___ ___ –___ ___ ___ ___–___ ___ ___ ___–___ ___ ___ ___ EXP . DATE : ____ / ____ o AMERICAN EXPRESS o DISCOVER
SIGNATURE : DATE :
COURSE REGISTRATION POLICIES
Cancellations ISD 622 Community Education reserves the right to cancel classes due to lack of enrollment or emergencies . Make-up lessons or refunds are only available for classes postponed by the program . There are no refunds or make-ups for student absences .
Refunds To be issued a refund , you must cancel your registration at least three business days before the class start date ( fifteen business days for day tours ). You will receive a refund minus a $ 5 service charge . No refunds or credits will be issued after the specified dates for classes and tours with a published cancellation deadline . Full refunds or credits are issued if Community Education cancels a class or tour , or the class or tour is already filled .
Closings Due to Weather In case of bad weather , tune in to local media – broadcast , print , and online for information on school closures , or check the district ’ s website at www . isd622 . org for the most current updates . Classes are not held when schools are closed due to the weather .
Assumption of Risk , Safety , and Responsibility for Class Content There is an inherent risk of accident , harm , and injury in any class , program , trip , outing , or activity (“ Activity ”). It is the responsibility of the participant to be aware that there are assumed risks in participation in any Activity . ISD 622 North St . Paul - Maplewood - Oakdale Schools ( the “ District ”) assumes no responsibility for any harm , injury , or damages incurred during activities . Any changes in participants ’ current physical activity level should be done under the approval and direction of their physician and / or health care provider ( s ). By participating in any District Activity , the District may rely on the representation and warranty of the participant that the participant is sufficiently physically fit to participate and does not have any medical condition ( s ) that would prevent the participant ’ s safe participation . Please refer to the Special Services section if you require a reasonable accommodation to participate in an Activity . Additionally , the opinions , presentations , and lectures of the instructor of a class are the instructor ’ s own and do not represent the opinions or positions of the District . If you believe an instructor has violated District policy , then such violations must be reported as required by the applicable District policy .
Special Services If you need reasonable accommodation to participate in a class or are planning to bring an aide , contact the Gladstone Community Education Office at 651-748-7250 at least 3 business days before the class start date . Service animals that meet the definitions of Title II and Title III of the Americans with Disabilities Act are welcome . Please leave other animals at home . Interpreters may be available upon request . Requests must be made at least 15 business days before a class start date and are subject to availability . Please contact the Gladstone Community Education Office at 651-748-7250 to request an interpreter .
Photos and Video Enrollment in classes or activities constitutes permission for the ISD 622 Community Education Department to take and use photographs , videos , and other likenesses of you and your enrolled minor child for use in Community Education promotional materials and publications . If you do not wish for the image and likeness of you or your minor child to be used in this manner , contact our department at 651-748-7250 .
UCare Discount If using your UCare enrollment to receive a discount on the cost of a Community Education enrichment course , you authorize the District to disclose your private data or other PHI to UCare and for UCare to disclose your PHI or other private data to the District .
PARTICIPANT SIGNATURE :