Beacon Community Class Registration

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Registration is limited and based on a first-come, first-served basis. 50% deposit due at time of registration to hold your spot, and can be paid at www.beaconlearning.org by clicking on the donation button at the bottom of the homepage. You can email info@beaconlearning.org if you have any questions or wish to arrange an alternative form of payment. Balance due on or before the first day of class.

Participant's Name *

Participant's Date of Birth *

Classes *

BUILD-A-CHAIR! Mondays 10-12:30, 4/1-5/20 12+ Tuition $240. Materials fee $40. 8 sessions

21st CENTURY GENETICS AND BEYOND Mondays 1-2:30, 4/1-5/20 12+ Tuition $180. 8 sessions

BIOLOGY OF DISEASES Fridays 10:30-12 4/5-5/17 , (no class on 4/12/19) Tuition-$135. 6 sessions

Required

How did you hear about us?

IMPORTANT INFO

Parent's name, address, phone number, and email *

Emergency Contact Phone Number/s *

Special medical information we should know. Please indicate if "none". *

May Beacon photograph and use your child's image on our website, Facebook, or in marketing materials?

Yes

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In consideration of my participation and the participation of my child/children in the activities of Beacon Self-Directed Learning, I hereby release Beacon from any and all liability for injuries or loss which I or my minor child/children may incur as a result of said activities for so long as I or my child/children participate in said activities. I hereby acknowledge that some activities may involve working with potentially dangerous materials. However, I fully accept these risks for me and my child/children and agree to hold harmless and free from any and all liability Beacon Self-Directed Learning, Inc., its governors, officers, directors, volunteers, and employees for injuries which may be incurred while engaged in said activities. My name below signifies my agreement and that I have read and understood the paragraph above. *

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