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Parent/Guardian
Name:______________________________________ Home
Phone:____________________________
Address:_________________________________________________Town:_______________________
zip:________
Email Address:_________________________________________________confirmation
choice: ____email ____phone
1st Child
Name__________________________Age: ____ 2nd Child
Name:__________________________Age: ____
Course
Name:___________________________________
Course
Name:____________________________________
Day/time:____________________ course Fee:_________
Day/time:______________________ course Fee:________
2nd Course
Name:________________________________ 2nd Course
Name:________________________________
Day/time:____________________
course Fee:_________ Day/time:_____________________ course
Fee:________
Session 1
__ $40/5wk
Session 2
__$40/5wk Session
1 __ $40/5wk
Session 2
__$40/5wk
(Starts week
of Jan 18 ) (Starts week of
Jan 18)
Both Sessions
__$75/10wks
Both Sessions __$75/10wks
Adult Bootcamp: __ $35.00/5wks __
$65.00/10 wks
Adult Bootcamp: __ $35.00/5wks __
$65.00/10 wks
Payment Info: Check #: _____Check Amount:
________ Emergency Contact:
Name_______________________ Phone: ______________
Mail
completed registration form along with payment to:
CRA Registrar, PO Box 40, Hampstead NH 03841
Registrations are on a first received, first registered basis. No
registration will be accepted without payment |