Darien Arts Center Class Registration Form (Arts, Dance and Theatre)

Fill out the form below, print it, SIGN IT, and send it in with your payment. Mail it to:
  • The Darien Arts Center
  • 2 Renshaw Road, Darien, CT 06820
  • Behind Town Hall
 or fax to 203-655-9470
If faxing, add credit card number and expiration date.
Name: Male Female
Age: Grade: Birth Date:
Address: Town: Zip Code:
Parent's Name: Email:
Phone - Home: Work/ Cell: Emergency:
Course #: Class: Day: Time: Tuition: $
Course #: Class: Day: Time: Tuition: $
Course #: Class: Day: Time: Tuition: $
OFFICE USE  
DDC
VAC
DAC
DKT 		Art Materials fee (if applicable): $
COSTUME FEE $45 per class grade 1 and up  
COSTUME FEE $35 per class preschool and K    		DANCE COSTUME FEE: $
Tuition Total: $
The DAC will only contact you if we are
unable to accept your registration		 Registration Fee: $
Donation to DAC: $
  Total Enclosed: $
Yes, I/we would like to contribute to the Darien Arts Center to help support the arts in Darien.
Artiste $50 Thespian $100 Virtuoso $250 Maestro $500 Other
Please make your checks payable to the Darien Arts Center. All contributions are tax-deductible.
Waiver: I will not hold the DAC liable for any injuries sustained to me or my child during DAC activities.
The DAC reserves the right to remove or reassign any student.
Signature:  
Credit Card: Number: Exp: