( ONE FORM PER PERSON / THIS

Winter 2024 registration form 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 _________________

Animal Humane Society Tour
January 31	___ $ 12
February 2	___ $ 12
Bagel Pizzas	___ $ 19
Beef Nachos	___ $ 19
Bingo
January 17	___ $ 11
February 8	___ $ 11
February 28	___ $ 11
March 6	___ $ 11
April 17	___ $ 11
Butterflies on a Canvas	___ $ 19
Candy Bar Bunny	___ $ 15
Crafty Artists Art Night !
January 25	___ $ 9
February 20	___ $ 9
Dinner at Acapulco	___ $ 22
Dinner at Davanni ’ s	___ $ 22
Dinner at Sammy ’ s Pizza
and Restaurant	___ $ 25
Easter Dirt Cake	___ $ 15
Egg Oreo Truffles	___ $ 15
Finding Nemo	___ $ 14
Friday Night Bowling
January 19	___ $ 22
February 9	___ $ 22
February 23	___ $ 22
March 8	___ $ 22
April 12	___ $ 22
Friendship Bracelets	___ $ 15
Garden Gnome	___ $ 15
Hawaiian Dance Party !	___ $ 15

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 : ______ / ______

Heart Sugar Cookies	___ $ 15
Herbert the Hedgehog Painting ___ $ 22
Hip Hop Dance	___ $ 19
How to make a Disc Hovercraft	___ $ 12
Indoor T-Ball	___ $ 35
Karate
Jan . 22-Mar . 4	___ $ 39
Mar . 18-Apr . 22	___ $ 39
Lego ® Social	___ $ 22
May Day Baskets	___ $ 12
Melted Crayon Art	___ $ 19
Merry Music Makers	___ $ 55
Moon Glow Ball Lamp	___ $ 24
Movie and Ice Cream	___ $ 12
Movie and Pajama Party	___ $ 12
Movie and Pizza Night	___ $ 19
Movie and Tacos	___ $ 19
Music with Claire	___ $ 12
Newsies	___ $ 14
Pool Party !	___ $ 12
Project Power Bowling Inv .	___ $ 22
Rainbow Bird House	___ $ 19
Slime and Playdough 101	___ $ 15
Special Olympics Basketball	___ $ 45
The Fun Lab	___ $ 39
Tree Stump Painting	___ $ 19
Tuesday Bowling League
Jan . 16-Feb . 6	___ $ 59
Feb . 13-Mar . 19	___ $ 59
Apr . 2-Apr . 23	___ $ 59
Valentine Wreath	___ $ 19
Water Aerobics	___ $ 15

Zumba Moving & Grooving
March 8	___ $ 15
May 3	___ $ 15

Staff / Caregiver Registration
Animal Humane Society Tour
January 31	___ $ 6
February 2	___ $ 6
Bagel Pizzas	___ $ 19
Beef Nachos	___ $ 19
Dinner at Acapulco	___ $ 22
Dinner at Davanni ’ s	___ $ 22
Dinner at Sammy ’ s Pizza
and Restaurant	___ $ 25
Feed My Starving Children	___ $ 0
Finding Nemo	___ $ 14
Hawaiian Dance Party !	___ $ 15
Movie and Ice Cream	___ $ 12
Movie and Pajama Party	___ $ 12
Movie and Pizza Night	___ $ 19
Movie and Tacos	___ $ 19
Newsies	___ $ 14
The Fun Lab	___ $ 39

Community Inclusion Activities
“ Dance the Night ” Line Dance	___ $ 19
“ Shake It Off ” Line Dance	___ $ 19
Easy Lavender Days Painting	___ $ 22
Feed My Starving Children	___ $ 5
Inclusion Bowling	___ $ 22
Paint by Number Kit	___ $ 19

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

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

Winter 2024 registration form FORM MAY BE REPRODUCED )