* 1. Student 1 Name and Grade

* 2. Student 2 Name and Grade

* 3. Who is authorized to pick up at 4:15 on Tuesdays?  (Please include Extended Care, if an option)

* 4. Emergency Phone Number(s) and Adult Name and Relationship to Student

* 5. Contact emails for class registration confirmation and any last minute location/class updates.

* 6. Payment Option (please select one)

* 7. Electronic Signature - please acknowledge your desire for participation and payment of this class.

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