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Name:________________________________________________ Email
Address:____________________________________________
Address:__________________________________________________ City:________________________ State:_____
Zip:____________
Phone
(Home):_______________________ (Other):________________________ Birthdate:____________
Sex: M ___ F ___
Previous
Riverbend Class: Yes ___ No ___ Center
Member: Yes ___ No ___ Exp.
Date:_____________ |
| Make
checks and money orders payable to: City
of Dayton
Mail
Payment to: Riverbend
Art Center, 1301 East Siebenthaler Avenue, Dayton,
OH 45414
Fees
must accompany registration form. Mail-in registrations
will be processed on a first-come, first-served
basis. Riverbend Art Center will send you a receipt
verifying enrollment. In consideration of my participation
in the classes, programs or activities of the
City of Dayton, Department of Recreation &
Youth Services, in addition to other good and
valuable consideration, I hereby release the City
of Dayton, Ohio and its officials, officers' employees,
representatives, agents and co-sponsors of and
from any and all claims, damages and liabilities
arising out of my or my child's participation
in any classes, programs or activities of the
City of Dayton, Department of Recreation &
Youth Services. In the event of an injury to myself
or my child, and if I or my spouse or my child's
legal guardian cannot be contacted, I hereby give
permission to the attending physician or other
medical or paramedical professional to render
treatment as would be normal and I further agree
to pay and be responsible for the usual and ordinary
costs incurred in such treatment. I understand
that participants in classes, programs or activities
may be videotaped, photographed or otherwise recorded
and that these records may be used by the City
of Dayton as it sees fit. I further agree to waive
any claim to such records or for compensation
for use of such records.
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Tuition and lab fees are listed under each class. There is an additional $10.00 fee charged for non-City of Dayton residents. Students provide their own materials unless otherwise specified. Lab fees are charged for materials that are supplied by Riverbend and used for the classes.
Riverbend
Art Center offers current students use of equipment
when it is not in use by a class. Non-student
members' usage of the facility must be approved
by the Cultural Affairs Senior Coordinator on
an individual basis. The lab fee is $1.00 per
hour or any part thereof, or 75 per hour for
Senior Citizens with a Golden Buckeye card.
Students
may register only during registration period.
Classes are filled in the order in which registrations
are received. Size of classes is limited. Most
adult classes last nine weeks, check 