REGISTRATION FORM

 

                  NAME:                                                                                                       

DATE OF BIRTH:                                           

           ADDRESS:                                                                                                        

                                                                                                                                       

                   CITY:                                               STATE:             ZIP:                        

 HOME PHONE:                                                 CELL:                                             

             E-MAIL:                                                                                                          

 EMERGENCY CONTACT:                                                                                       

                                PHONE:                                                                                        

 

    Please complete this form and bring it with you to our Fall Open House, or e-mail it to Lesa Palmer: lesadpalmer@gmail.com