1. Sign Up

Class Information

Location: Google Children's Centers : Fields Day: Friday Class: PK Time: 10:55-11:25am Dates: 10/5/18 — 12/7/18 Meetings: 7 Class Price: $105.00

Student Information

*First Name:

Last Name:

Date of Birth: (mm/dd/yy)

Parent/Guardian Contact Information

First Name: Address/P.O.Box: City:

Last Name: Suite or Apt.: (optional)

State: ZIP/Postal Code: Country: Email Address:

Phone #1:

ext.

Phone #2: (optional)

ext.