Children Program Registration

Mail Payment To:
Class Name:
Number of Classes:
Instructor:
Class Beginning Date:
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Dec 31, 1969
Class End Date:
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Dec 31, 1969
CLass Time:
Recommended Age:
Location of Class:

Student Information

Child's Name
Gender
Male
Female
Age
Emergency Contact Phone
Any food allergies or religious or cultural food, personality/ developmental concerns? My indicating your concerns we can the accommodate you needs.

Parent Information/Guardian

Name
Email
Daytime Phone
Evening Phone
Payment Information (select one)
I will be mailing a check along with the registration form
I would like an invoice emailed to me