IDRC class registration • April 12, 2021

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Please correct the field(s) marked in red below:

Please note that you must be scheduled for this class date in order to register. If you register and you were not previously scheduled, you will not be allowed to attend. Staff will reach out to anyone should there be any issues or change. Please fill out the registration in its entirety.

Personal Information

*

Personal Information

First Name

Last Name

Date of Birth

Driver's License

Street Address

City

State

Zip Code

Phone Numberext.

Email Address

By registering I agree to the following:

By registering I agree to the following:

I confirm that I am able to speak and understand English.

I confirm that I have photo identification and will bring with me to class to verify my identify.

I confirm I am able to pay the class fee of $264 in full. This will be due the first night of class in the form of Money order or certified (bank) check ONLY (no other payments accepted).

I confirm that I will be required to wear a face covering and am able to do so. It will be my responsibility to bring my own face covering as it will NOT be provided.

I confirm that I have not tested positive for COVID-19 within the last month.

I confirm that I have not had any COVID-19 specific symptoms within the last month which according to the CDC includes: fever or chills, cough, shortness of breath of difficulty breathing, fatigue, muscle por body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea.

I confirm that I am not aware of any potential exposures of COVID-19 within the last month.

Please call our office at 908-704-6304 if you foresee any barriers to attending the class.

We are requesting that you bring your own writing instrument (pen, pencil) to the class. Please also be sure to bring food with you as food deliveries are not permitted nor will you be able to leave the premises once registered.

To receive a copy of your submission, please fill out your email address below and submit.
Email Address

To get COVID questions answered, please submit your questions online to get a quick response.