Class Registration

Deposit received: date________________ Amount_____________

Parent(s) name: _________________________________________

e-mail _________________________________________________
Phone numbers: (h)_________________________(c)_________________________
Address:_______________________________________________

______________________________________________________

Students:
Name:______________________________ DOB_______________
Name:______________________________ DOB_______________
Name:______________________________ DOB_______________

Please circle the programs you are registering for:

School Year
2010-2011
Pre-Summer
2011
Summer
2011
LocationMicrotel in YorkMicrotel in YorkYour pool, Stageneck (Members only), or Pierce Island in Portsmouth
DatesSept 13, 2010 - April 28, 2011May 23, 2011 - June 9, 2011July 5, 2011 - Aug. 15, 2011
*class information

1/2 hour classes
Monday AM or PM
Tuesday AM or PM
Wednesday AM or PM
Thursday AM or PM
Mon/Wed AM or PM
Tues/Thurs AM or PM
Monday
Tuesday
Wednesday
Thursday
Friday
TeachersAnn - M/W/Th
Patty - Tuesday
AnnAnn and Eliza
Costs1-2 students/class-$690
3-4 students/class-$460
1-2 students/class-$180
3-4 students/class-$125
1-2 students/class-$175
3-4 students/class-$120