Middle School Booster (Winter Sign Up)

Parent Name*

First Name Last Name

Parent Email*

Phone*

How did you hear about the workshop?

Student Information

Student Name*

Pronouns

e.g. he/him, she/her, they/them

School Attending

Grade (in Fall)*

Student Notes*

Does the student have any learning disabilities, behavioral issues, special dietary requirements, or any other issues we should be aware of?

Emergency Contacts*

Name, phone, email, relationship to student

Ticket	Price	Quantity
Student	$410.00	Sold out
Discount:	-$
Total	$

Discount Code

Workshop Terms & Conditions*

Cancellations must be made in writing 30 days prior to the workshop. With this notice, cancellations will be refundable minus a $45 service fee. Cancellations in writing within 21-30 days will be refunded half the paid fee. There will be no refunds less than 21 days prior to the workshop. Any student who is disruptive to the workshop or discourteous to teachers or other students will have one brief private discussion with an instructor and a warning. Students will be asked to leave for subsequent disruptions.

I have read and agree to the terms and conditions detailed above.

Middle School Booster (Winter Sign Up)

Workshop Registration

Student Information