Date

YYYY

1. Student Name (First / Last)

First Name

Last Name

1. Birth date

YYYY

Classes

list of classes being offered, please indicate a preference, we will try to accommodate.

Parent / Guardian

If student(s) are under the age of 18 please indicate the parent / Guardian name

First Name

Last Name

Address

Primary Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Primary Contact Phone Number

(###)

###

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Registration Form - One per Student