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 208th - 12th grade - March 125th - 7th grade - March 265th - 7th grade - April 23
Student Name*

First NameLast Name
School *
Grade*

5th Grade9th Grade6th Grade10th Grade7th Grade11th Grade8th Grade12th Grade
Adult Contact*

First NameLast Name
Phone Number*

Area CodePhone 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 NameLast Name
Adult Participant #2

First NameLast 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.
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Registration Form