Registration

Student's Name: __________________________________________________

Phone: __________________ Age: ________ Birth Date: ____/____/______

Address: __________________________________ City : _________________

Zip: ____________ E-Mail: ________________________________________

Mother's Name: ________________________ Wk. Phone: ______________

Father's Name: _________________________ Wk. Phone: ______________

Any Health Problems? _____________________________________________

Signature: ____________________________________ Date: _____________

Class Level: ______________ Day:_____ Time: _____ Day: _____ Time: _____

Day : _____ Time: _____ Day: _____ Time: _____

Just print it

Fill it out

and

Hand it in!