Ukulele Class

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Ukulele Class

Free Class for Youth Center Members taught by Rolando, a Masters Level Music Teacher in Akron.

Parent Name

Must have custodial rights to register children.

Child's Name (please complete one form per child) *

I understand that failure to complete a separate form for each of my children will result in only one child participating in the program. *

Yes, I understand.

Mailing Address *

City *

Zip Code *

Parent Email *

Parent Phone Number *

Child's Current Grade Level *

6th

7th

8th

9th

10th

11th

12th

I will be contacting the Cloverleaf Bus Garage to make arrangements for my child to ride the bus to the center.

I will notify you in advance once this arrangement has been made.

Yes. I will connect with the bus garage and let you know how it works out.

No. I will be making other arrangements.

My child is a current member of the Youth Center and my account is up to date. *

Yes. My child's membership status is active.

No, we are not members.

I understand that all fees must be paid by 5 pm Thursday, September 15th.

I understand that I can choose to either:

1) Pay for a Daily Visitor Pass ($8 per day for 3 days = $24) or

2) I can register my child as a Youth Center Member for $20/month (minimum 1 month registration).

If I choose to register my child, they will also have access to the other programs.

I understand that fees are not refundable.

My children are already members of the Youth Center.

I wish to register my children to be members of the Youth Center (Minimum 1 month)

I choose to pay for the Visitor Day Pass (6-pass purchase for $48 required)

I understand that for my children to participate in the programs at the center, I will need to complete releases for my family. *

Yes. I understand and agree to complete the releases prior to my child being left at the facility.

Required

Lodi Family Center is a not for profit ministry focused on providing youth and families access to fun, social, and educational opportunities. Youth participating in our programs are required to behave as they would at school. No violence of any kind is acceptable nor inappropriate language.

We are an agency that respects others and promote diversity and inclusion. This institution does not discriminate on the basis of race, color, national origin, sex (including gender identity and sexual orientation), disability, age, or reprisal or retaliation for prior civil rights activity.

We strive to provide a safe environment for everyone that visits.

I understand and agree that my family will be respectful and polite.

I understand that inappropriate behavior and actions (we follow and support school rules) will result in the removal of my child/children from the program. I agree to ensure that myself or another emergency contact are available at all times that my child is at the Center.

YYYY

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms