Community Education - current class catalogs Families - Winter 2015

registration forms ECFE FAMILY INFORMATION (Please print legibly) Parent(s) attending _________________________________________________________ _______________________________________________________ First Last First Last ECFE, 2727 Ferry St., ECFE Mail to:MN 55303 •N.763-506-1275 Anoka, Home or primary phone ____________________________________________________ Cell___________________________________________________ Work phone ______________________________________________________________ Other Phone ___________________________________________ Address______________________________________________________ City ________________________________ Zip code_______________________ Email address_______________________________________________________ r Yes, I would like to receive ECFE newsletters and other class info by email. All children attending class, including infants: First and last name_____________________________________________________________________ Birthdate_____________________ r boy r girl First and last name_____________________________________________________________________ Birthdate_____________________ r boy r girl First and last name_____________________________________________________________________ Birthdate_____________________ r boy r girl Riverview classes only: List child(ren) attending sib care: First and last name_____________________________________________________________________ Birthdate_____________________ r boy r girl First and last name_____________________________________________________________________ Birthdate_____________________ r boy r girl ECFE CLASS REGISTRATION - Registration also accepted online at www.discovercommunityed.com Class number Location Mail to: Community Schools • 763-506-1260 See page 36 for specific addresses of class locations CS Class Title_____________________ r VISA r MasterCard r Discover Exp. Date______________ Fee 1st choice class fee r Cash r Check No._______________ (payable to ECFE) $______________ Card No. __ __ __ __ –__ __ __ __ –__ __ __ __ – __ __ __ __ Signature___________________________________________________________ Parent(s) Name Day 1st Choice Alternate Choice Fees can be adjusted due to inability to pay. I can pay $______________ r Cash r Check No. ___________ (payable to AH Dist #11 Comm. Ed.) Home phone_________________Work/Cell __________________ r VISA r MasterCard r Discover Address_________________________________________________ Card No. __ __ __ __ –__ __ __ __ –__ __ __ __ – __ __ __ __ City______________________________ Zip____________________ Exp. Date_________ Signature__________________________ Email address____________________________________________ Course No.______________ Class title______________ _ ee $_____ Location_________________Day/Time_____________ r boy r girl F Course No.______________ Class title______________ _ ee $_____ Location_________________Day/Time_____________ r boy r girl F Course No.______________ Class title______________ _ ee $_____ Location_________________Day/Time_____________ r boy r girl F *Please complete and mail or drop off a seperate form and payment for each class location. Total payment enclosed $__________________________________ Child last name____________________________________ First name __________________________________ Birthdate_________________ Does your child have health, behavior or other special needs?_______________________________________________________________ www.discovercommunityed.com 39

Community Education - current class catalogs Families - Winter 2015 | Page 39