SUMMER 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 ___________________

4th of July Crafts					___ $ 12
Anoka Aquatic Center					___ $ 14
Bingo
May 7					___ $ 11
June 12					___ $ 11
July 10					___ $ 11
August 28					___ $ 11
Bowling League
May 7 - May 28					___ $ 59
June 3 - June 24					___ $ 59
July 8 - July 29					___ $ 59
Bunker Park Stables Barn Tour					___ $ 15
Cactus Rock Craft					___ $ 12
Ceramic Painting					___ $ 19
Cheeseburger Roll Ups					___ $ 19
Chili Cheese Dog Bake					___ $ 19
Crafty Artists Art Night !
May 23					___ $ 9
July 30					___ $ 9
Dessert in the Park					___ $ 12
Dinner at Sammy ’ s Pizza
and Restaurant					___ $ 25
Dinner and Treats at DQ
June 11				___ $ 15
Cheeseburger		Hot dog		Chick . strip
July 23				___ $ 15
Cheeseburger		Hot dog		Chick . strip
Aug 20				___ $ 15
Cheeseburger		Hot dog		Chick . strip
DIY Wood Birdhouse				___ $ 19
Dust Devil T-ball				___ $ 42
Small	Medium		Large		XXL
Edible Food Art snacks					___ $ 19
Feed My Starving Children					___ $ 9

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 : _______ / _______

Friday Night Bowling
May 17	___ $ 22
June 7	___ $ 22
June 21	___ $ 22
July 19	___ $ 22
Aug 9	___ $ 22
Games , Coloring and Cookies	___ $ 12
Hawaiian Bowling Night	___ $ 22
Ice Cream in a Bag 101	___ $ 12
Juicy Lucy ’ s and Homemade Fries	___ $ 22
Lilli Putt	___ $ 22
Kickball	___ $ 35
Mac and Cheese	___ $ 19
May Day Baskets	___ $ 12
Mother ’ s Day Gift	___ $ 12
Movie and Pizza Night	___ $ 19
Movie and Popcorn	___ $ 9
Music with Claire	___ $ 12
Painting Lucky the Llama	___ $ 22
Painting a Summer Pineapple	___ $ 22
Performance in the Park –
Pair of 7	___ $ 9
Performance in the Park –
Tricia and the Toonies	___ $ 9
Spring Dance	___ $ 15
Superhero Bowling Night	___ $ 22
Water Bottle Firefly	___ $ 12
Zumba Moving & Grooving	___ $ 15

Staff / Caregiver Registration
Edible Food Art snacks		___ $ 19 ( if eating )
Cheeseburger Roll Ups		___ $ 19 ( if eating )
Chili Cheese Dog Bake		___ $ 19 ( if eating )
Dessert in the Park		___ $ 4 ( if eating )
Dinner and Treats at DQ
June 11		___ $ 12 ( if eating )
Cheeseburger	Hot dog		Chick . strip
July 23		___ $ 12 ( if eating )
Cheeseburger	Hot dog		Chick . strip
Aug 20		___ $ 12 ( if eating )
Cheeseburger	Hot dog		Chick . strip
Dinner at Sammy ’ s Pizza
and Restaurant		___ $ 25 ( if eating )
Feed My Starving Children		___ free
Games , Coloring
and Cookies		___ $ 6 ( if eating )
Juicy Lucy ’ s and
Homemade Fries		___ $ 22 ( if eating )
Lilli Putt		___ $ 19 ( if golfing )
Mac and Cheese		___ $ 19 ( if eating )
Spring Dance		___ $ 9 ( if eating )
Movie and Pizza Night		___ $ 19 ( if eating )
Movie and Popcorn		___ $ 9 ( if eating )

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 .

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 - Summer 2024 | Page 15

SUMMER 2024 registration form