Registration Form

(Please Print)      Registration Date: _____________________________________

If under 18: Age: ____ Parent's Names: _________________________________

Street: _____________________________________________________________

Town, State, Zip: _____________________________________________________

Telephone: Home: ____________________________________________________

Cell: ____________________________ Work: _____________________________

Email: _____________________________________________________________

Allergies and/or medications you would like the school to be aware of:

___________________________________________________________________


Semester:   ___ Winter     ___ Spring     ___ Summer     ___ Fall

Course: ____________________________________________________________

Day of Week: _______________________________   Time: ________________

(Summer only):   Week:   1    2    3    4    5    6     Time: ___ am  ___ pm

Payment Method: Check # ________ Amount: $__________________________

Cardholder Name: ____________________________________________________

Expiration Date:_______________ Amount:$______________________________

Refund Policy: 1. Student receives a full refund if the school cancels a course. 2. Student receives a full refund if course is filled and he/she does not wish to apply tuition to another course. 3. Student receives a full refund - minus a $25 registration fee - if he/she withdraws 10 or more days prior to the first class. 4. Student receives a 50% refund if he/she withdraws one to nine days prior to the first class. 5. No refunds will be issued on or after the first day of class. 6. No refunds for missed classes due to personal reasons.

Signature (parent, if student is under 18): ________________________________