Fall 2024 registration form

( ONE FORM PER PERSON / THIS FORM MAY BE REPRODUCED )

Participant / Staff information : ( No participant substitution without prior notice .)

Name of Participant name : ______________________________________ Phone : _______________ Group Home : ________________

Address : __________________________________________________________ City : _____________________ Zip : ___________

Email : __________________________________________ ( for class confirmation )

Birth date : _____ / _____ / ________ REQUIRED - Legal guardian / Emergency contact ( must be able to be reached during class time .): ________________________________

_______________________ ____________________________ ______________________

Legal guardian name Phone No . Emergency contact name Phone No .

Special Accomodations : � Wheelchair � Allergies ______________________________ � Other _____________________________ Staff must remain on site : � Yes � No Photo Release : � Yes � No � ASL Interpreter ___________________

Anoka Middle School Play		___ $ 15
Basketball		___ $ 39
Bingo
Sep 18		___ $ 11
Oct 16		___ $ 11
Oct 30		___ $ 11
Nov 13		___ $ 11
Dec 18		___ $ 11
Candy Canes		___ $ 12
Capture the Arts		___ $ 32
Cocoa and Carols with Claire		___ $ 12
Crafty Artists Art Night !
Sep 26		___ $ 9
Nov 21		___ $ 9
Dinner and Treats at DQ		___ $ 15
Cheeseburger	Hot dog	Chick . strip
Dinner at Sammy ’ s Pizza & Restaurant ___ $ 25
Floor Hockey		___ $ 39
Friday Night Bowling
Sep 20		___ $ 22
Oct 4		___ $ 22
Oct 25		___ $ 22
Nov 15		___ $ 22
Dec 13		___ $ 22
Gingerbread House		___ $ 19
Grand Slam		___ $ 22
Grinch Cookies		___ $ 19
Halloween Bowling Night		___ $ 22
Halloween Dance		___ $ 15
Halloween Gingerbread Haunted House ___ $ 19
Hayride and Bonfire		___ $ 19
Ice Cream Social		___ $ 12

Payment is due at the time of registration . Refund and cancellation policy : requests with at least five business days notice from the class start date are eligible for a refund minus a $ 10 processing fee . Refund requests with less than five business days notice from the start of class are not eligible for a refund .

Payment information :

Participant total : $ __________ Staff total : $ __________ UCare member No .: _________________________________ Paper check : Payable to “ Anoka-Hennepin Schools ” All checks processed electonically . Credit card : Cardholder name ____________________________________________________ Card No .:__________ - __________ - __________ - _________ Exp . date : _______ / _______

Intro to Pickleball	___ $ 12
Karate	___ $ 35
Leaf Bowl	___ $ 12
Lilli Putt	___ $ 22
Meatball Boats	___ $ 19
Merry Music Makers	___ $ 32
Movie and Pizza Night	___ $ 19
Movie and Sub	___ $ 19
Mummy Dogs	___ $ 19
Music with Claire – Country Songs	___ $ 12
Music with Claire – Holiday Songs	___ $ 12
Owl Painting	___ $ 22
Pancake Tacos	___ $ 19
Pool Party !	___ $ 12
Project Power Bowling Invitational	___ $ 22
Pumpkins	___ $ 12
Rhythm and Bells	___ $ 42
Santa Hat Cupcakes	___ $ 19
Santa Jar	___ $ 12
Solar Light Luminaires	___ $ 19
Spider Cookies	___ $ 19
Table Tennis	___ $ 12
Taylor Swift Dance Party	___ $ 12
Thanksgiving Dinner	___ $ 15
Vikings Museum	___ $ 49
Water Aerobics
Oct 25	___ $ 15
Nov 7	___ $ 15
Dec 10	___ $ 15
Zumba Moving and Grooving	___ $ 15
Zumba Moving and Grooving
– Neon Night !	___ $ 15

COMMUNITY INCLUSION ACTIVITIES
Beyonce ’ s “ Texas Hold ‘ em ’” Dance !	___ $ 15
Holiday Inclusion Bowling Night	___ $ 22
Inclusion Bingo	___ $ 11
Inclusion Hayride and Bonfire	___ $ 19
Jeremy Ross Painting “ Taylor Swift Theme !” ___ $ 22

STAFF / CAREGIVER REGISTRATION
Anoka Middle School Play		___ $ 15
Dinner and Treats at DQ		___ $ 15 ( if eating )
Cheeseburger	Hot dog		Chick . strip
Dinner at Sammy ’ s Pizza & Restaurant ___ $ 25 ( if eating )
Grand Slam		___ $ 22 ( if participating )
Grinch Cookies		___ $ 19 ( if eating )
Halloween Bowling Night		___ $ 22 ( if bowling )
Halloween Dance		___ $ 9 ( if eating )
Hayride and Bonfire		___ $ 19
Ice Cream Social		___ $ 12 ( if eating )
Inclusion Hayride and Bonfire ___ $ 19
Lilli Putt		___ $ 22 ( if golfing )
Meatball Boats		___ $ 19 ( if eating )
Movie and Pizza Night		___ $ 19 ( if eating )
Movie and Sub		___ $ 19 ( if eating )
Mummy Dogs		___ $ 19 ( if eating )
Pancake Tacos		___ $ 19 ( if eating )
Santa Hat Cupcakes		___ $ 19 ( if eating )
Spider Cookies		___ $ 19 ( if eating )
Thanksgiving Dinner		___ $ 15 ( if eating )
Vikings Museum		___ $ 49

Check out our simple online registration and payment options . ahschools . ce . eleyo . com

Mail completed form and payment :

Anoka-Hennepin Community Ed . Attn : Project Power 2727 N . Ferry St ., Anoka , MN 55303

or FAX form to 763-506-1299 CALL us at 763-506-1290

Feel the power of YOU !

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Community Education - current class catalogs Project Power - Fall 2024 | Page 15

Fall 2024 registration form