Marion Community School of the Arts, Inc. Online Registration

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First day of classes: Week of August 21, 2023 Payments are due the 1st of the Month September through May, late fees will be assessed after the 15th of each month if account is not paid in full. You have until 14 days from the start of the class to drop the class without penalty. After 14 days you will be charged a $25 drop fee per class.

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Referral Information

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Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Info*

Health Insurance Carrier

Enter Coupon Code

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Marion Community School of the Arts, Inc.. Standard message and data rates apply. Reply STOP to opt out

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

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Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name*

Last Name*

Type

How can we contact you?

Home Phone

Work #

Cell # * Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Marion Community School of the Arts, Inc.. Standard message and data rates apply. Reply STOP to opt out

Email* (Emails are kept confidential)

Confirm Email*

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Marion Community School of the Arts, Inc.. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Medical Conditions, Disabilities, or Special Needs*

Medications*

Allergies*

Approved Over Counter Meds (Tylenol, Advil, Bayer, Aleve, Benadryl, Midol, Neosporin, Cough Drops)*

Primary Doctor*

Enroll in Classes

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Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Marion Community School of the Arts, Inc.. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Medical Conditions, Disabilities, or Special Needs*

Medications*

Allergies*

Approved Over Counter Meds (Tylenol, Advil, Bayer, Aleve, Benadryl, Midol, Neosporin, Cough Drops)*

Primary Doctor*

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Marion Community School of the Arts, Inc.. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Medical Conditions, Disabilities, or Special Needs*

Medications*

Allergies*

Approved Over Counter Meds (Tylenol, Advil, Bayer, Aleve, Benadryl, Midol, Neosporin, Cough Drops)*

Primary Doctor*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Marion Community School of the Arts, Inc.. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Medical Conditions, Disabilities, or Special Needs*

Medications*

Allergies*

Approved Over Counter Meds (Tylenol, Advil, Bayer, Aleve, Benadryl, Midol, Neosporin, Cough Drops)*

Primary Doctor*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Marion Community School of the Arts, Inc.. Standard message and data rates apply. Reply STOP to opt out

Additional Info

Student Email

T-Shirt Size

School*

Grade Level*

Medical Conditions, Disabilities, or Special Needs*

Medications*

Allergies*

Approved Over Counter Meds (Tylenol, Advil, Bayer, Aleve, Benadryl, Midol, Neosporin, Cough Drops)*

Primary Doctor*

Enroll in Classes

Select Class

Add Another Student

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Questions or Concerns

Comments

Payment Information

Account Information

e-Payment Schedule*

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Credit Card

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Exp Month

Exp Year

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Address Line 1

Address Line 2

City

State

Zip

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Routing Number (9-digit number)

Account Number

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Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Who is your employer?

Contact #2

How can we contact you?

Who is your employer?

Student #1

Additional Info

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Student #2 (Show-Hide Details)

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Student #3 (Show-Hide Details)

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Student #4 (Show-Hide Details)

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Student #5 (Show-Hide Details)

Additional Info

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Questions or Concerns

Payment Information

Account Information

Credit Card

eCheck/Bank Draft

Required Policies

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