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Class Information

Location: Google Children's Centers : Woods Day: Wednesday Class: Woods PS - Maple Time: 3:50-4:20pm Dates: 10/2/19 — 11/27/19 Meetings: 9 Class Price: $135.00

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.