Registration

Payment will be due prior to the first day of the class. If this is a recurring class, you only need to fill out the form once.

Parent/Guardian Name:*

First

Last

Child's Name:*

Child's Date of Birth:*

Home Phone:*

Area Code

Phone Number

E-mail Address:*

Your address:

Street AddressCityState / Province / RegionPostal / Zip Code

Class you are registering for:

By clicking submit, you agree that participation is entirely voluntary and at your own risk. You are permitted to assist your child at any time during the class. You agree not to hold Advanced Wellness and Education Center, LLC liable for any injury that may occur while participating in the class.

Type the characters you see here:

* Indicates required fields