Boggess Elementary After School Hip Hop Classes
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: * Zip: *
Emergency Contact Info*
Students entered below will be added to your family's account
Emergency Contact Name*
Emergency Contact Phone Number*
Homeroom Teacher*
Dismissal Method: Car Pool, Walk, Pasar*
Additional Information:
Class Description, Dates & Times
  (Show-Hide Details)
I've read the above and agree.
Approval To Charge Credit Card
  (Show-Hide Details)
I've read the above and agree.
Medical/Publicity Waiver
  (Show-Hide Details)
I've read the above and agree.
Enter your Full Name: *   
Other Questions/Comments:
Credit Card Verification:
Card Number: *  
Name as it appears on card: *
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*