REGISTRATION FORM WAYS TO REGISTER1. PREFERRED! ON-LINE: commed.dmschools.org 3. MAIL: 2100 Fleur Drive, Des Moines, IA 50321 (Credit Card Only) 4. IN PERSON – Bring your completed registration form to:2. PHONE: 242-8521(Credit Card Only) 2100 Fleur Drive, Des Moines, IA 50321Please use one registration form for each individual registrant. You may photocopy this form if additional forms are needed.How did you learn about this class? (Check all that apply.)p Catalog p e-Mail p Instructor/Coach/School p Repeat/Prior Student p Social media (Facebook, Twitter, etc.) p T.V.p Website p Word of mouth p Otherp Yes! I would like to receive e-mail announcements of special events, and reminders when registration begins each session.(Please print legibly)Today’s Date________________________ Your Name_____________________________________________________________________Address___________________________________________________________________________________________________________City________________________________________________ State___________________________________ ZIP+_________________Home Phone_____________________________________Cell Phone_____________________________ Work Phone_________________e-Mail____________________________________________________________________________________________________________Your date of birth:____________________________________ Do children under age 18 reside in your household? p Yes p No(For youth program registration only)Name of Child______________________________________________________________ Date of Birth____________________________Emergency Contact Name_____________________________________________________ Relationship____________________________Home Phone________________________________ Cell Phone________________________Work Phone____________________________Current Grade______________________________ Current School Attending_________________________________________________p I, and/or my child, prefer not to be photographed for use in district publications, websites or local media and newspapers.I certify that the above is correct, and the individual listed above has my permission to enroll in the Des Moines Public Schools program(s) below.Des Moines Public Schools, its agents and representatives will not be held liable for any injuries, loss of property or accidents during this program.Parent/Guardian Signature___________________________________________________________________________________________Course Number Course Title Start Date Fee TOTAL FEESPayment Method: p Check (Number ) p MasterCard p VISA p DiscoverPlease make checks payable to DMPS Community Education. Do not send cash. If you wish to charge your registration to your VISA, MasterCard or Discover,please fill in the following:Account Number __________ - __________ - __________ - __________ Exp. Date____________________________________________________Cardholder Signature___________________________________________ 2100 Fleur Drive 51 Des Moines, IA 50321
2100 Fleur DriveDes Moines, Iowa 50321commed.dmschools.orgWinter/Spring 2018 Class Catalog | Vol. 27, Issue 2 25PAGE No matter your financial goals, we offer the class for you. See our listings on page 25. 29PAGE “The greatest wealth is health.” We offer a variety of classes that will help you achieve your health and wellness goals. 41PAGE Looking to take your knitting to the next level? Take a look at our new “Knitting with Color” classes on page 41! NEW WEBSITE! FOLLOW US ON SOCIAL MEDIA! @DMPSCOMMUNITYEDWe have a new website: commed.dmschools.orgPlease take a look! The website is easier to use and Watch for our social mediainteractive. You’ll be able to pull up the catalog, push a presence. You may get a tweet orbutton to start registering and make a suggestion for a see a post on our Facebook pageclass you would like to see! about your favorite class.
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