Name: _______________________________________ Age: ____________
Address: _______________________________________________________
City: __________________________ State: __________ Zip: __________
Daytime Phone: ____________________ e-mail: ____________________
Parent or Guardian Signature: ___________________________________
Allergies or other conditions to be aware of: _____________________
_________________________________________________________________
Class Number
Title
Fee
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Total Fee: $______________