Program Registration

*Student name:     **Please enter your name

Parent’s name:  
(if applicable)

*Street address:

*City:                      *Zip:
**Please enter your full address

Home phone:

Cell phone:      **Please enter at least one phone number.

*Email:     **Please enter a valid email address

Class Name Session Fees
  Total fees:

**Please select at least one class


Note: Payment is due by the first class. You can bring a check with you to class, or you can call the Center
(352-383-0880) with your credit card.