REgistration

Please review carefully before submitting. Errors on this form will influence the scheduling and logistics of your attendance.

Name *
Name
Date of Birth *
Date of Birth
Phone *
Phone
Address *
Address
What weeks are you attending The Illustration Academy *
This is only used for housing purposes. Rockhurst does not permit coed dorm floors.
If so which one?
Section
EMERGENCY CONTACT INFORMATION
Primary Emergency Contact *
Primary Emergency Contact
Emergency Contact Home phone *
Emergency Contact Home phone
Emergency Contact Cell Phone *
Emergency Contact Cell Phone
Emergency Contact Work Phone *
Emergency Contact Work Phone
Secondary Emergency Contact *
Secondary Emergency Contact
Emergency Contact Home phone *
Emergency Contact Home phone
Emergency Contact Cell Phone *
Emergency Contact Cell Phone
Emergency Contact Work Phone *
Emergency Contact Work Phone
Are you 18 or older? *
Students applying or attending the Illustration Academy must be 18+ or have written permission from a parent or legal guardian. If you are not 18+, this process must be completed by a parent or legal guardian. Please have them contact us at hello@theillustrationacademy.com
I have read the entire Liability Release, The Illustration Academy’s Sexual Misconduct Policy and Rockhurst University’s Handbook. I fully understand each and I agree to be legally bound by all. *