PARENT CLASS REGISTRATION | Green's Learning Academy

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Multiple Items *

This is a six week course. Class will be held once a week starting.

I understand *

the class price is $456. If I am unable to attend this amount is non refundable as it reserves your spot in my class due to limited availability.

Child Care *

How many kids will be in Child Care

Cost: $10 per child per week

Child #1 Name, Age and and important info (allergies, toileting needs, behavior concerns etc. )

Child #2 Name, Age and and important info (allergies, toileting needs, behavior concerns etc. )

Child #3 Name, Age and and important info (allergies, toileting needs, behavior concerns etc. )

Child #4 Name, Age and and important info (allergies, toileting needs, behavior concerns etc. )

Child #5 Name, Age and and important info (allergies, toileting needs, behavior concerns etc. )

Additional Charge added for Child Care

Please list the cost for Child(ren) here

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Card

Name on Card

Parent Class Registration Form