*1.Name of participant (first and last)(Required.)

*2.Street Address #1 (St. # and Name)(Required.)

3.Street Address #2 (Apt./Unit) if applicable

*4.City(Required.)

*5.State(Required.)

*6.Zip Code(Required.)

7.Phone Number

*8.Email Address(Required.)

*9.Is the participant UNDER 18 years of age?(Required.)

Yes (If so, a guardian must be present during the class)

No

*10.ACKNOWLEDGMENT: I understand that I will be required to sign an agreement for myself and/or for any participant under 18 years of age for whom I am the parent or legal guardian before participating.(Required.)

Yes

No