Parent   Last Name:First Name:

Daytime Contact #:

Evening Contact #:

Age of Child:     Sex: 

Years of Experience: 

Current USAG Level:(optional)

What days work best for you? 

What times work best for  you?

(erase any that do not work)  Additional Comments or Requests

I AM INTERESTED IN :

Request for class information

MaleFemale

0 yr.1yr2-3yrs4+years

Lev. 1-3 Lev.4-5Lev. 6-7Lev. 8+

Enter days in this box

(Camps) 9am-12pm. (Camps) 12pm-3pm (class) evenings 4:15 (class)evenings 5:30 (class)evenings 6:45 (class)mornings 9:00 (class)mornings 11:00

CAMPSCLASSESBOTH