Student Name:
Grade: 7th 8th 9th 10th 11th 12th Age: 12 13 14 15 16 17 18
Address:
City: ZIP:

Phone:
School:
Father's Name:
Mother's Name:

Course Selections (Title/Day):
1st choice:
2nd choice:
3rd choice:
4th choice:

You will be billed for the $50 registration fee (one per family).
The balance, plus book fees, will be billed in September and must be paid [or a payment plan established] by September 26th.