Registration Form
Please print this page for registration
**$20.00 registration fee**
For Office Use Only:
Enrollment Date: ________________________ Registration Fee Paid: _______________________
Name ____________________________________________ Date of Birth: ______________________
Address ____________________________________________________________________________
City/Zip __________________________________ Home Telephone __________________________
E-mail address________________________________________________________________________
Parent/Guardian (if under 18) __________________________________________________________
Parent(s) Work Telephone __________________________
Emergency Contact _____________________________________ Telephone ____________________
General Health _________________________________ Allergies? _____________________________
Is student on any medication? ___________________________________________________________
Class Enrollment:
Class Name ___________________________________ Tuition Fee ______________________
Day/Time _____________________________
Instructor ______________________________
Additional Classes:
Class Name ___________________________________ Tuition Fee ______________________
Day/Time _____________________________
Instructor ______________________________
Class Name ___________________________________ Tuition Fee _______________________
Day/Time _____________________________
Instructor ______________________________
Registration Form