JCC Community Education ~
REGISTRATION FORM ~ Winter/Spring 2008Name:___________________________________________
Address:_________________________________________
City:_________________________________
Phone: (H)_______________________________(C)_____________________________
E-mail Address:_______________________________________________________
UCare ID # if applicable_________________________________________________
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___ 1805 Tae Kwon Do (Youth): $40 per month ___ 1815 Little Huskies Cheerleading: $35 ($10 no apparel) ___ 1825 Pom Dance: $30 ___ 1835 Beginning Knitting: $25 ___ 1850 CPR #1 March: $35 ___ 1851 CPR #2 April: $35 ___ 1860 Beginning Computer: $30 ___ 1861 Beginning PowerPoint: $30 ___ 1863 Photo Organization Workshop: $19 or $49
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___ 1865 Tae Kwon Do (Adult): $40 per month ___ 1870 Def. Driving 4-hour, April 1: $15 Driver’s License # ____________________________ ___ 1872 Def. Driving 4-hour, April 19: $15 Driver’s License # ____________________________ ___ 1874 Def. Driving 8-hour, April 19: $20 Driver’s License # ____________________________ ___ 1884 Farm Transfer and Estate Planning: Free ___ 1886 Medical Assistance and Long-term Care: Free
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Follow directions in class descriptions or contact instructor directly for: ABE, Adult Men’s BB, ECFE, Fine Arts events,Firearm Safety, 4-H Adventures, Groovin’ with the Oldies, Libraries, Love & Logic, Prairie Ecology Bus Center, ROMEOsand JULIETs, Student Driver’s Education, Turbo Kick, and Yoga.
If applicable: I, as a parent/guardian, grant permission for (participant)___________________________________
By granting permission, I, as a parent/guardian, accept full responsibility for any injury incurred or accident that may
occur during the course of practice or games or activities.
Parent/Guardian_______________________________________________________Date_________________