Education Class Registration Form - Octagon Center for the Arts
Education Class Registration Form - Octagon Center for the Arts
Classes

Education Class Registration Form

Please complete the registration form to register for: camps, classes, workshops and special education department events.

Due to online form design, please only register one student per registration form. Sorry for the inconvenience.

 

Registration is not completed until payment is received, Please call the Octagon, 515.232.5331, to submit payment by card or mail a check to the Octagon at: Octagon Center for the Arts, 427 Douglas Ave, Ames Iowa 50010.

Please call 515.232.5331 if you have any questions or would like to register over the phone.

* denotes a required field.
Student Name and Age: *
Address: *
City: *
Zip Code: *
Day Time Phone Number: *
Cell Phone/ Alt. Phone Number: *
Email Adress: *
Emergency Contact/ Parent Name: *
In case of emergency whom should we contact?  
Emergency Contact Phone Number: *
Allergies/Health Concerns:  
Please list any important and vital allergies or health concerns we should be aware of.  
Photo Release: *
By signing this box, I understand that the Octagon may use photos of students, and artwork in their publications. Names will never be listed.  
Class Information- Class Name: *
Please list the class you are registering for.  
Instructor for the Class:  
Please list, if available, the instructor for the class you are registering for.  
Dates for the Class: *
Cost: *
Please note the cost of the class.  
Class Information- Class #2 Name:  
Please list the class you are registering for.  
Instructor for the Class #2:  
Please list, if available, the instructor for the class you are registering for.  
Dates for the Class #2:  
Cost #2:  
Please note the cost of the second class.  
Class Cost Total Before Discounts: *
Please enter the total of the above classes, before discounts have been taken.  
Membership Discount 10%:  
Please note your membership level if you are a member of the Octagon to receive your 10% discount on camps, classes, and workshops.  
Interested in a Membership at the Octagon?:  
Please note here if you are interested in learning about the wonderful membership opportunities that the Octagon Center for the Arts offers.  
Grand Total: *
Please list the grand total of your above classes, including your membership discount here.  
Verification Code: *
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