Summer Class Registration

Registration *

New Student Returning Student

Payment for the month of:

June July August

Choose Start Date *

Date Date Picker Icon

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 *

Email *

Confirmation Email Invoices and other school notices are sent to emails on file

Address *

Street Address
Street Address Line 2
City
Zip Code	Country

Emergency Contact Name *

Same as above

Emergency Contact Number *

Same as above

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

Additional Comments/Notes

Tuition & Fees

New Student Registration Fee $ 30.00

Students

Monthly - 2 hour $ 145.00

MONTHS (per student):

Monthly - 1.5 hour $ 135.00

MONTHS (per student):

Sibling Discount $ -10.00

Summer Semester - 2 hours $ 385.00

Quantity

Summer Semester - 1.5 hour $ 360.00

Quantity

Single Class - 2 hour (NOT trial class) $ 35.00

DAYS (per student)

Single Class - 1.5 hour (NOT trial class) $ 32.75

DAYS (per student)

Total $ 0.00

Payment Information
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

*

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Summer 2019 Class Registration