| Name:_______________________________________________________
Age: __________ |
| Parent or Guardian:
___________________________________________ |
| Street or P.O. Box:
____________________________________________ |
| City:
____________________________ |
State: _____________
Zip:__________ |
| Phone (home):____________________ |
Phone (other):______________________ |
| Email:
_______________________________________ |
|
|
Please
circle one:
I have/ have not taken lessons previously
I am registering for (please check which lessons apply): |
|
|
|
WALK ON FEE -
$12.00 PER SESSION |
|
PROGRAM COST
IS $120 FOR A 9 WEEK SESSION
$10.00 ANNUAL REGISTRATION FEE
|
| Total Payment Enclosed: |
|
$_____________ |
