EmailMe Form - Oakland Asian Cultural Center

Date Time *

MM / DD / YYYY

Student Name *

First Last

Student Gender *

Male

Female

Student Ethnicity *

Student Age *

Student Date of Birth *

Parent's Full Name *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Email *

Preferred Method of Communication *

Email

Mail

Phone

Class Information

Class *

Time

Day

It is the parent's responsibility to pick up the child/children as soon as class is over.

The parent's of students shall hold all instructors & OACC harmless from any and all damages and injuries during classes and performances at all times. By typing your name below, you are agreeing to these terms.

General Policies:
* All classes are catered on a first come first serve basis.
* You must complete and sign workshop registration form to participate in any OACC class or workshop.
* If you miss a class, you may make it up (subject to class instructor's discretion) but no refund will be given.
* OACC reserves the right to cancel class that does not meet the minimum enrollment.
* OACC has the right to cancel classes in case of emergencies that would compromise our student's safety.

Payment Policies:
* If you are taking a monthly class, payment is due on the first class date of each month.
* If you are late with class payment, a charge of $10.00 per class will be added to your class fees.
* You will be removed from class session if you fail to make payment.
* Please turn in all class payments to OACC front desk.
* All payments must be made by cash, credit card, or check.
* Please make check payable to Oakland Asian Cultural Center (OACC).
* All payment is final, no refunds.

Penalty Charge:
A $25.00 fee will be charged on returned check and "payment stopped" check.

I have read and will comply with the above General Policies, Payment Policies and Penalty Charge. *

Signature

Date

Emergency Contact

Emergency Contact Name *

First Last

Emergency Contact Relation to Student *

Emergency Contact Phone Number *

### - ### - ####