Program you are registering for:(Required)

Little Stars (ages 5-9) Every Wednesday from 3:45-4:30pm ($180)

Junior Company (ages 10-12) Every Wednesday from 4:30-6:00pm ($360)

Teen Company (ages 13-17) Every Wednesday from 6:00-7:30pm ($360)

Participant Name(Required)

First Last

Age of participant as of first class(Required)

Parent/Guardian Name

First Last

Phone(Required)

Email(Required)

Is there anything else you'd like to share prior to the class?

Total

Credit Card

Cardholder Name

Card Details

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