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Evening Class Registration
Parent/Guardian Last Name *
First Name *
Address *
City *
State *
Zip *
Email Address *
Phone *
Work Phone
Emergency Contact *
Relationship *
Phone *
Date You Would Like to Start Class *
Type of Membership *
Month-to-Month
6 Month
12 Month
Family Membership? *
Yes
No
Student 1*
Date of Birth *
Age *
Student 2
Date of Birth
Age
Student 3
Date of Birth
Age
Student 4
Date of Birth
Age
Student 5
Date of Birth
Age
Student 6
Date of Birth
Age
Submit