ENROLLMENT FORM

REGISTER BY MAIL OR DROP THIS

REGISTRATION at the WASC

Registration Begins December 1, 2006 

Classes will be held on five Saturdays – January 13^th and 27^th; February 10^th and 24^th, and March 10^th

at the West After School Center

The program will run from 1:00 p.m. to 3:00 p.m. each of those Saturdays.

Student Name:

Grade Level:

Parent Name:

Address:City & State:

Tel # (home)

Tel # (work)

Tel # (emergency)