Adolescent Brain Class

Registration Form

Please fill in the form below.
Class Choice - All classes are Thursdays from 6 - 7pm at Twin Hills Middle School in Sebastopol. *

5th - 7th grade - February 20 8th - 12th grade - March 12 5th - 7th grade - March 26 5th - 7th grade - April 23
Student Name *

First Name Last Name
School *
Grade *

5th Grade 9th Grade 6th Grade 10th Grade 7th Grade 11th Grade 8th Grade 12th Grade
Adult Contact *

First Name Last Name
Phone Number *

Area Code Phone Number
E-mail *
Will an adult be attending the separate adult class? *
Space in class is not secure until payment is made through PayPal or arrangement with instructors. If you would like to pay with cash or check, please contact Andrea at 707.481.8213. Thank you.
Adult Participant(s)
Adult Participant #1

First Name Last Name
Adult Participant #2

First Name Last Name
Additional Information
Registration fee is $10.00 for each student. No charge for adults. Please click on the Submit button below and follow instructions to send payment to finalize registration.
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform

Registration Form