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* 1. Student 1 Name and Grade

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* 2. Student 2 Name and Grade

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

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

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

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* 6. Payment Option (please select one)

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

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