STUDENT NAME *

First Name

Last Name

WHICH SESSION WOULD YOU LIKE TO REGISTER FOR? *

Morning, 10:00 a.m. to 12:15 p.m. (EDT)

Afternoon, 1:00 p.m. to 3:15 p.m. (EDT)

PARENT / GUARDIAN NAME *

First Name

Last Name

PARENT / GUARDIAN CELL PHONE NUMBER *

(###)

###

####