Direct Bill Class Registration Request Form

If you need to register your client* for one of our classes via direct bill you must fill out the form below to ensure we have the required information for registration and invoice processing, regardless if you’re a returning student or not. *Example: ARC or BHSN

Please note: due to Residential Resources’ (RR) change in invoicing policies effective January 1, 2024 the Strand Center for the Arts is no longer able to provide direct bill to RR clients.

STUDENT/CLIENT INFORMATION

Student/Client Name

First Name

Last Name

Student/Client Mailing Address

Student/Client Email

Student/Client Phone

(###)

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CONTACT INFORMATION

Contact Name

First Name

Last Name

Contact's Relationship to Student/Client

Contact Email

Contact Phone

(###)

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REGISTRATION & INVOICE INFORMATION

What class(es) are you interested in registering your client for?

Please include title and date of class.

Students Age? (If under 18)

How did you hear about this class?

Allergies/Medical

Does your child have any allergies or medical conditions we should be aware of?

Do you give the Strand Center for the Arts permission to capture your (the attendee) likeness via video and photo for promotional purposes?

Invoice Information

Please include the service provider's name, agency contact's name, billing address, phone number, and email address for the invoice.

By checking the box below I acknowledge that this is a request for services and not a completed registration. Once reviewed and approved a staff member will respond with completed registration information.

I understand this is a request and registration is not confirmed until I receive a separate email with registration confirmation and invoice.

By checking the box below I acknowledge that if my service provider declines payment I am personally responsible to pay the full outstanding balance due to Strand Center for the Arts regardless of attendance. I understand and will abide by Strand Center for the Arts' refund policies.

I understand and agree to pay the full invoice balance due to Strand Center for the Arts if my service provider declines payment and I understand the Strand Center for the Arts' refund policy.