CASYM Registration Form 2019
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CASYM 2019 KIDS STEEL PAN CLASS REGISTRATION FORM
STUDENT INFORMATION
Child  Name *
Address *
City/State/Zip *
Date Of Birth *
MM
/
DD
/
YYYY
Gender *
Required
Student Status *
Required
GUARDIAN INFORMATION
Guardian Name *
Cell Number *
E-mail *
MEDICAL INFORMATION
CASYM INC. makes an effort to provide a safe and secure environment for your child during every session. In order to better protect the safety and health of your child, we request that you provide emergency contact information. We request that the parent/guardian provide another contact (not living at the same address) who is authorize to act or his/her behalf should the parent not be available.      
EMERGENCY CONTACT
SAME AS ABOVE *
Required
GUARDIAN NAME
Cell Phone
Please List all allergies including food, medicine, seasonal or latex *
CLASS INFO
Class Location:
 St. Francis of Assisi
400 Lincoln Rd, Brooklyn, NY 11225
The Entrance is on Lincoln Rd in the church parking lot

Class Day and Time:
Steel Band Class Starts Friday September 27th 2019.
Class  One Time: Friday 6:00PM to 7:30PM             Saturday: 12:00PM to 1:30PM
Class Two Time: Friday 7:30PM to 9:00PM              Saturday:   1:30PM to 3:00PM
PHOTO WAIVER FORM    
To protect the privacy and safety of CASYM Inc. program participants, personal information about participants (such as birthdates, email addresses or phone numbers) will not be published on any CASYM Inc’s, web page under any circumstance.
Please note that no permission is required for large group photos in which the students are not individually identified.
 
DISCLAIMER
I am aware that still photos and videos of my child may be taken on the premises of any CASYM Inc. program site as well as during any off-site sanctioned extra- curricular activity (i.e. recitals, field trips, etc.).
I am aware that still photos and video may be posted to website and/or be used in a variety of collateral printed pieces (i.e. brochures, newsletters, flyers, print ads). The pictures/video will be used for the purpose of illustrating, advertising and promoting the activities associated with CASYM, Inc.’s programs.

 
I have read the disclaimer and agree to allow my child to be photographed. *
Required
 How did you hear about this program? *
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