Adult Enrichment Registration Form
NAME: HOME PHONE:() WORK PHONE:() CELL:() STREET ADDRESS: CITY: STATE: ZIP:
EMAIL ADDRESS: By providing your email, you will receive course confirmations, reminders, updates, and cancellation notices. Your information will not be shared outside of the ISD 622 Community Education program.
EMERGENCY CONTACT: EMERGENCY CONTACT PHONE:() CLASS # PARTICIPANT NAME( FIRST, LAST) CLASS NAME COST o
CHECK( Payable to“ District 622”— will be handled as a one-time electronic fund transfer or draft)
o VISA o MASTERCARD o AMERICAN EXPRESS o DISCOVER
UCARE / HEALTHY BENEFITS + CARD NUMBER: ____ ____ ____ ____ –____ ____ ____ ____–____ ____ ____ ____–____ ____ ____ ____ AMT.
SUBTOTAL UCARE / HEALTHY BENEFITS + AMOUNT
TOTAL COST
EXP. DATE: ___ /___
CARD NUMBER: ____ ____ ____ ____ –____ ____ ____ ____–____ ____ ____ ____–____ ____ ____ ____ AMT.
EXP. DATE: ___ /___
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 651-748-7630.
PARTICIPANT SIGNATURE: