VSA arts of Nevada Registration Form 
Print and Fax to 337-6107, Mail to 250 Court St, Reno, NV 89501, or email info@vsanevada.org 

PRE-REGISTRATION REQUIRED FOR ALL CLASSES ~ Please make checks payable to VSA arts of Nevada.  
Classes are limited in size and are offered on a 'first come first served" basis. Students needing to withdraw from a class after registering may receive a tuition refund less $5 administrative cost if VSA arts of Nevada is notified five business days before the first session of class. No refunds thereafter. Scholarships are available.  Download, print and send in scholarship application with registration form. You will be contacted regarding the status of your scholarship. 

Participant __________________________________School________________   Age _______ M / F

Home Address _____________________________ City ___________    State _____    Zip _______

Daytime Phone ____________________________   Second Phone ____________________________

Email Address ______________________________________________________________________
   Please provide your e-mail address so we can send you new class schedules and special events information.

Emergency Contact _________________________________Phone ___________________________
         
Where did you hear about this program?____________________________________________

I, the undersigned, agree to hold VSA arts of Nevada, City of Sparks, Washoe County, and the Directors of these programs, harmless from all suits, claims, or demands of every kind and character arising out of and in connection with this program. In case of accident or illness, the fore mentioned/VSA arts has my permission to secure medical attention as deemed necessary if unable to communicate with me immediately. I hereby grant permission to VSA arts of Nevada to utilize my or my child's artwork, appearance, name, voice and likeness to help promote VSA arts of Nevada in any and all manner and media. VSA art programs are open to all children/adults. If you need a reasonable modification for a person with a disability or allergy, please describe below.

___________________________________________________________________________________

_______________________________________         _____________________________________
Parent's/Guardian's or Individual's Printed Name      Parent's/Guardian's or Individual's Signature

Credit Card Visa/MC# ___________________________________________________________ Exp. date _________

Name of Cardholder _______________________________Cardholder's Signature ___________________________