Registration Form

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New Brunswick Community College, St. Andrews Campus

Summer 2010 course registration
Student name(s) and age(s):
Course name	Cost & proficiency level (if applicable)
	$
	$
	$
Total $ (Canadian):
Parent or guardian name (if student under 19): Phone E-mail		Address:
Method of Payment (minimum 50% deposit) Cheque or Money Order (enclosed) Please make cheque payable to the St. Andrews Arts Council. Visa Card # Exp Date (year) Balance if any is due before classes begin.
How did you hear about the courses? _______________________________________________ Signature ______________________________ Today's date: 2010

Liability waiver (must accompany application form):
I, ___________________________ (name of student, or parent/guardian if student is under 19), the undersigned, being fully aware of the dangers and risks to life, limb and property that may arise from and in relation to the activity being applied for in the above application form, hereby release, discharge and save harmless St. Andrews Arts Council Inc., its directors, officers, employees and agents from and against all losses, claims and causes of action arising out of or in any way related to the said activity, whether such losses, claims and causes of action are the result of any act, omission or negligence of the said St. Andrews Arts Council, its directors, officers, employees, agents, or any other person or thing.
Signature ______________________________ Today's date: 2010 (2010) Witness ______________________________ Today's date: 2010 (2010)
Print off this completed page and mail to: St. Andrews Arts Council Inc., 99 Augustus Street, St. Andrews, NB E5B 2E9