Community Education - current class catalogs Project Power - Summer 2017

Summer 2017 registration form (ONE FORM PER PERSON / THIS FORM MAY BE REPRODUCED) Participant/Staff information: (No participant substitution without prior notice.) Participant name: _____________________________________________________________ Phone: _______________________________ 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. Class/Event Animal Humane Society Tour Art in the Park Silhouette Painting Bowling League June Bowling & Pizza Bowling only Eating only July Bowling & Pizza Bowling only Eating only August Bowling & Pizza Bowling only Eating only Concert in the Park June - Blaine July - Coon Rapids Cooking 101-Pasta Salad Dinner at Dairy Queen June July Dinner at Perkins Fairy Garden Clay House Father’s Day Gift Feed My Starving Children Fourth of July Flag Friday Night Bowling with Dirk and Perry June Bowling & Pizza Bowling only Eating only July Bowling & Pizza Bowling only Eating only August Bowling & Pizza Bowling only Eating only Grand Slam Jackson Street Roundhouse Museum Kickball Lilli Putt Mini Golf and More Movie and Pizza at the Theater June July Picnic in the Park Shrek the Musical Summer Baking-Fruit Pizza Summer Birthday Party Swimming at Anoka Aquatic Center Treasure Island ___________________________ __________________ Emergency contact name Participant Staff/caregiver Phone No. Medical conditions or needs: ______ $9 ______ $15 ______ Free Please specify information to instructor they may need to be aware of (dietary, behavioral or other). ______ $55 ______ $30 ______ $55 ______ $30 ______ $25 ______ $55 ______ $30 ______ $25 ______ $55 ______ $30 ______ $25 Allergies: ______ $55

Community Education - current class catalogs Project Power - Summer 2017 | Page 15