Classes

Register for a Class

Please complete this form to register for a Community Education class at Madisonville Community College.

Name	Birthdate
Street Address
City	State	Zip
Home Phone	Mobile Phone	Work Phone
Email Address
Course Title
Meeting Dates
Where did you hear about Madisonville Community College Community Education classes?
Brochure in the newspaper	Word of mouth	Brochure at work
Mail at home	Other

Important: If the participant is under the age of 18, the following information is required.

I grant approval for my child to participate in the Youth Enrichment Series (YES) class / classes and release Madisonville Community College and any instructors and assistants from any liability arising from his / her participation in said class / classes. I understand the college does not provide health or medical insurance for participants. Consent is hereby given to Madisonville Community College, Youth Enrichment Series instructors or supervisors to give or seek medical aid required in the case of emergency. My child's photograph and name may appear in print ads or the college's publications for Community Education while engaged in campus activities and classes.

Parent's Name

Parent's Phone

Name of additional person who may be contacted in case of emergency

Phone