REGISTRATION FORM | WINTER/SPRING 2026
Register by Mail: Fill out the form below and mail to :
Community Education , 2575 W. 88th St., Suite 200, Bloomington, MN 55431 Make checks payable to ISD 271
BLOOMINGTON COMMUNITY EDUCATION CLASS REGISTRATION FORM
Participant’s Name _______________________________________________________________________________________________________________ Address________________________________________________________________City____________________________________ Zip______________ Preferred Phone_ _____________________ Can we text you? Yes No Email (required) _ _________________________________________________ This information is required for participants under age 18 and requested for those over age 18: Participant’s Date of Birth_____________________ If student: Grade _ __School____________________________________________________ Emergency Contact 1_ __________________________________________________ Phone_____________________________________________ Emergency Contact 2_ __________________________________________________ Phone_____________________________________________ COURSE # TITLE START DATE TIME FEE __________________ __________________________________________ _________________ __________________________ $____________ __________________ __________________________________________ _________________ __________________________ $____________ __________________ __________________________________________ _________________ __________________________ $____________ ƛ Check (payable to ISD 271) ƛ Cash CHARGE MY : ƛ MasterCard ƛ Visa ƛ Discover Card ƛ Am. Ex. Total = $ ____________ Card #: _______________ - _______________ - _______________ - _______________ Expiration:_____________________________________________ Cardholder Name: ________________________________________ Signature:____________________________________________________________ By registering for this class, all participants are indicating that they are participating of their own initiative and if the participant is a minor, parents or guardians assume all risk relating to or resulting from participation in the class. By registering, the participant or parent or guardian of the class participant RELEASES the Bloomington Public School District, Bloomington Community Education, their officers, employees and/or volunteers and the Class Instructor from any action, claims, and/or expenses of any kind the participant may acquire which arise directly or indirectly from the participation in the class. The participant or parent or guardian of the participant further agrees to INDEMNIFY Bloomington Public Schools, Bloomington Community Education, their officers, employees and/or volunteers and the Class Instructor from any loss, damage or costs resulting from participation in the class. *Bloomington Public Schools uses a service called Advantage Collections to recover any checks written to the District for insufficient funds and other reasons returned to the District. A state-allowed fee of $30 will be charged for each check returned by a bank for insufficient funds. This is in addition to the face amount of the check. Once a check is returned, the District cannot accept a new check. The check writer must work with Advantage Collections directly. Their phone number is 763-689-1500. (Duplicate this form as needed)
With great generosity comes great reward. Your time donation as a volunteer makes a difference in the lives of others; in return they enrich yours.
(952) 681-6114 metrosouth.org
This program is partially funded with a grant from the Minnesota Department of Education using state and/or federal funding. Minnesota Statute Section 124D.522 and/or CDA 84.002, Adult Basic Education-Grants to States. A proud partner of the American Job Center network.
44 | BLOOMINGTON COMMUNITY EDUCATION | WINTER/SPRING 2026 | REGISTER: BLOOMINGTON.CE.ELEYO.COM | 952-681-6132 HELP WITH EL• ADULT DIPLOMA• GED• COLLEGE PREP• CAREER PATHWAYS
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