Please include $25 Registration Fee.

Date ____________

Student Name _________________________

Age_____ Birthdate ___________________

Address ______________________________

City _________________________ State ____ Zip _________

Guardian Name(s) _____________________________________

Home Phone ____________________

Work Phone ____________________

Cell Phone _____________________

Student Cell Phone _______________

Guardian Email Address ________________________________

Student Email Address _________________________________

Classes to enroll in (please include name of class and day):

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

As classes fill quickly, please include a second choice. Thank you.