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Registration Form
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| (Please Print) |
Date:_______________________________ |
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| Last Name:_______________________________________ First name:_____________________________________________ |
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| Age:_______________________________ Birthdate:__________________________________ Sex:______________________ |
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| Address: (Street)_____________________________, (City) _________________________, (State)_____, (Zip)______________ |
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| Mailing Address: (PO Box)______________________, (City)__________________________, (State)_____, (Zip)______________ |
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| Class:_________________________________ Day:_____________________ Time:___________________ Cost:___________ |
| List any medical conditions we should know about (allergies, seizures, asthma etc…) |
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| ______________________________________________________________________________________________________ |
| (Child #2) |
| Last Name:______________________________________ First name:______________________________________________ |
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| Age:_______________________________ Birthdate:__________________________________ Sex:______________________ |
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| Class:_________________________________ Day:_____________________ Time:___________________ Cost:___________ |
| List any medical conditions we should know about (allergies, seizures, asthma etc…) |
| ______________________________________________________________________________________________________ |
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| _______________________________________________________________________________________________________ |
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| List any medical conditions we should know about (allergies, seizures, asthma etc…) |
| _______________________________________________________________________________________________________ |
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| _______________________________________________________________________________________________________ |
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| Name of parent to notify:________________________________ Phone:____________________ Alt. Phone:_________________ |
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| Address: (Street)______________________________, (City) _________________________, (State)_____, (Zip)______________ |
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| Name of parent to notify:________________________________ Phone:_____________________ Alt. Phone:________________ |
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| Address: (Street)______________________________, (City) _________________________, (State)_____, (Zip)______________ |
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| There is a $15.00 registration fee per child annually, with a max of $45.00 a
family. All children must have an adult present during class times. Lesson prices are first 2 children reg price and 1/2 off for remaining children. |
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| Contact us: 207-396-5300 |
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