offLine Registration

Self-Improvement Class Student Registration

offLine Form – Please Print/Complete/Mail

Right Click and Select ‘Print’ HotKeys: Cntrl+P

Name of Student:
**Required**
If under 18 years of age
Parent’s name:
**Required**
Indicate Class Dates for Which This Registration Applies
**Required**

E-mail or Contact:
**Required**
Cell Phone:
**Required**
Likes/Dislikes/Allergies:
Information that will help us succeed. **Required**
Other information:
End of Class PickUp: We are required by law to call 911 if your child is not picked up before: 5:00 PM
Photo Release Signature:
Parent’s sign here to give permission to have child’s picture in the news
Liability Release: I hereby waive any right I may have to make a claim against G.K.C.C. for monetary damages caused by injury to my Child arising from my Child’s participation in these activities.

I have carefully read this agreement and fully understand its contents. I am aware the agreement includes a waiver of liability, an assumption of risk, and an agreement by me to indemnify the releases, and I sign it of my own free will.

Graham/Kapowsin Community Council

(253) 279-3071
10806 240th St E
Graham, WA 98338
http://g-kcc.org
https://www.facebook.com/GrahamKapowsinCommunityCouncil
gkccouncil@gmail.com

Linking community through learning … where the impact is great!

Info. is provided as a public service announcement & does not represent sponsorship or endorsement by Bethel School District.

 

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