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Please complete the following information
* Required Field
Student's Name *
FIRST - LAST
Workshop/Class Name *

Student Status
Returning Student
New Student
Date of Birth *
Parent/Guardian's Name
(MINORS ONLY)
Phone *
Alt Phone
E-Mail *
Please add my email to the Portland Taiko enews list
Address *
City-State-Zip *
Please add my email to the Portland Taiko mailing list
Emergency Contact *
Emergency Phone *
Alt Phone
Please list any allergies
Please list any special needs
Additional Comments
Payment Options
Full Tuition
$
Deposit
Class space may be reserved with a non-refundable deposit of $50. Tuition balance is due two weeks before the start date of class.
Balance Due: $

Payment Method

Online

Bill Pay

Check by Mail:
Portland Taiko
3230 NE Columbia Blvd.
Portland, OR 97211-2032
Refund Policy
Class registration withdrawal requests that are received two weeks prior to the start date of the class are eligible for a full refund minus a $50 processing fee. Requests received after that time will be credited to your next class registration. Workshop refund requests are only eligible for credit. Credit expires one year from date of issue. All refunds and credits are subject to Portland Taiko approval.
Photo Release
YES, Portland Taiko may use photos & video of me and/or my child for promotional purposes.
Liability Release *
I authorize the directors, employees, teachers, and assigns of Portland Taiko to secure proper treatment for myself or my child in a medical emergency. I release and discharge Portland Taiko from any and all claims for personal injuries. I am (or my child is) physically fit to practice and engage in the intensive physical program normally connected with Taiko training and there is no reason known to me/my child for not participating in these activities. This agreement shall remain in effect until I have actively ceased any activity with Portland Taiko and have also given 30 days written notification of intent of being released from this wavier.

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