Summer 2019 Class Registration
June 3rd - August 24th
Registration
*
New Student
Returning Student
Payment for the month of:
June
July
August
Choose Start Date
*
-
Month
-
Day
Year
Date
Student's Name
*
First Name
Last Name
Age
*
"A" for Adults
Grade
if applicable
School
List any allergies or medical conditions the school needs to be aware of
Will sibling also be attending?
*
Yes
No
Student's Name
*
First Name
Last Name
Age
*
Grade
if applicable
School
List any allergies or medical conditions the school needs to be aware of
Parent/Customer Name
*
Contact Number
*
Format: 0000000000.
Email
*
Confirmation Email
Invoices and other school notices are sent to emails on file
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Emergency Contact Name
*
Same as above
Other
Emergency Contact Number
*
Same as above
Other
Once a week
*
2 hour
1.5 hour
1.5 hour Classes
*
Tuesday 4:30 pm - 6:00 pm
Tuesday 5:00 pm - 6:30 pm
Thursday 4:30 pm - 6:00 pm
Thursday 5:00 pm - 6:30 pm
2 hour Classes
*
Tuesday 4:30 pm - 6:30 pm
Thursday 4:30 pm - 6:30 pm
Saturday 10:00 am - 12:00 pm
I give my permission for my child's / my photo and artwork to be used in promotional material. Only first name, last initial and age will be used for credit line.
How did you hear about us? Please check all that apply
*
Internet Search
Driving By
Facebook
Friend Referral
Other
Additional Comments/Notes
Tuition & Fees
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( X )
New Student Registration Fee
$
30.00
Students
1
2
Monthly - 2 hour
$
145.00
MONTHS (per student):
1
2
3
4
5
6
Monthly - 1.5 hour
$
135.00
MONTHS (per student):
1
2
3
4
5
6
Sibling Discount
$
-10.00
Summer Semester - 2 hours
$
385.00
Quantity
1
2
Summer Semester - 1.5 hour
$
360.00
Quantity
1
2
Single Class - 2 hour (NOT trial class)
$
35.00
DAYS (per student)
1
2
3
Single Class - 1.5 hour (NOT trial class)
$
32.75
DAYS (per student)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Total
$
0.00
Payment Information
*
Submit
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