Community Education - current class catalogs Project Power - Summer 2018

Summer 2018 registration form

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

Animal Humane Society Tour 6- 7 p. m.		______ $ 9	______ Free
7- 8 p. m.		______ $ 9	______ Free
Annie Jr., the Musical		______ $ 15	______ $ 9
Bowling with Dirk and Perry
Jun. 8	Bowling & pizza	______ $ 25	______ $ 25
	Bowling only	______ $ 15	______ $ 15
	Eating only		______ $ 10
Jul. 20	Bowling & pizza	______ $ 25	______ $ 25
	Bowling only	______ $ 15	______ $ 15
	Eating only		______ $ 10
Aug. 10	Bowling & pizza	______ $ 25	______ $ 25
	Bowling only	______ $ 15	______ $ 15
	Eating only		______ $ 10
Clay Portraits		______ $ 10
Cooking 101-Chicken Kabobs		______ $ 19	______ $ 9( if eating)
Dinner at Acapulco		______ $ 22	______ $ 15( if eating)
Dinner at Dairy Queen Jun. 26		______ $ 15	______ $ 9( if eating)
Jul. 25		______ $ 15	______ $ 9( if eating)
Dinner at Golden Corral		______ $ 19	______ $ 15( if eating)
“ Echos of Elvis” Concert in the Park		______ $ 9
Feed My Starving Children		______ $ 5	______ Free
Felting Fabric		______ $ 15	______ $ 12( if eating) ______( No. of staff riding bus)
Grand Slam		______ $ 19	______ $ 15( if participating)
Kickball		______ $ 29
Lilli Putt Mini Golf and More		______ $ 19	______ $ 10( if participating)
Madagascar, A Musical Adventure		______ $ 25	______ $ 19
Mosaic Tiles		______ $ 25
Movie and Lunch at Cinema Grill		______ $ 15	______ $ 12
Movie and Pizza at the Theater Jul. 28		______ $ 19	______ $ 15
Aug. 18		______ $ 19	______ $ 15
Picnic and Outdoor Games		______ $ 19	______ $ 12( if eating)
Summer Bowling League
Jun. 4- 25	Bowling & pizza	______ $ 55	______ $ 55
	Bowling only	______ $ 30	______ $ 30
	Eating only		______ $ 25
Jul. 9 – 30	Bowling & pizza	______ $ 55	______ $ 55
	Bowling only	______ $ 30	______ $ 30
	Eating only		______ $ 25
Aug. 6 – 27	Bowling & pizza	______ $ 55	______ $ 55
	Bowling only	______ $ 30	______ $ 30
	Eating only		______ $ 25
Swimming in the Sun		______ $ 15	______ Free
Train Ride to Gameworks		______ $ 25	______ $ 19
Twins Baseball Game		______ $ 35	______ $ 29
West Side Story, the Musical		______ $ 35	______ $ 29

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

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. Emergency contact name Phone No.

Class / Event Participant Staff / caregiver Medical conditions or needs:

Please specify information to instructor they

may need to be aware of( dietary, behavioral or other).

Allergies: Food Medication( specify)

__________________________ ASL interpreter: Yes No Photo release: Yes No( See p. 16)

Seizure: Active Non-active

An active seizure disorder MUST have a primary staff or caregiver with participant at all times.

Autistic Behavioral Walker Wheelchair

Payment information:

Participant total: Staff / caregiver total: Check Number:

$ ________________ $ ________________

__________________

Make check payable to: Anoka-Hennepin School District

OR Credit card:

Cardholder name:

Visual impairment Staff must remain on site: Yes No

Other:( specify)

___________________________________________

Card No.: _ _ _ _- _ _ _ _- _ _ _ _- _ _ _ _

Exp. date: ______ / ______ Mail completed form and payment:

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

Or FAX registration to 763-506-1299 Or CALL registration to 763-506-1290

Community Education - current class catalogs Project Power - Summer 2018 | Page 15

Summer 2018 registration form