Registration

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Home Phone:	Cell #: Work #:
	Email:	(Emails are kept confidential)

	Address: *
	City: *	State/Prov: * Postal Code: *
	Emergency Contact Info (Not Contact #1 or #2)*

Students entered below will be added to your family's account

Questions/Options:

Additional Information:

Parent-&-Child Classes

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