DSA-U Winter Semester Is Open!

DSA-U Winter Semester is Open!

All abilities welcome including friends, siblings and individuals with developmental disabilities.

For questions regarding the DSAGSL campus, contact Erin at 314.961.2504. For questions regarding The St. Charles Academy of the Arts, please contact Sandy at 636-946-9779.

Participant Name______Date of Birth: ______Date: ______

Parent/Guardian Name(s) ______

Phone (___)______E-mail______

Address______City______State______Zip______

** Please check below next to the classes for which you would like to register. Please note fees vary by session ** Has your son/daughter participated in DSAGSL programs previously? Yes/No: ______

Does the participant have any food allergies or medical concerns?

Yes/No: ______If yes, please describe: ______

Does participant have any other special needs (medical, behavioral or otherwise) that we should be aware of?

Yes/No: ______If yes, please describe: ______

By signing this form, I acknowledge that I have alerted the Down Syndrome Association of Greater St. Louis (DSAGSL) and St. Charles Academy of the Arts of any allergies, medical or behavioral concerns that may result in mishap or injury of my child during participation in DSA-U programs. I acknowledge that the DSAGSL will do everything in their ability to avoid such mishap or injury and I hereby release officers, staff, and volunteers should any such mishaps or injury occur.

Printed Name ______Signature ______

In case of emergency, notify:

Name______Relation ______Phone Number (___)______

Return registration form and payment to DSAGSL, ATTN: Erin, 8531 Page Ave, Suite 120, St. Louis, MO 63114

OR via email to [email protected] OR via fax to (314) 989-1579