Registration
Please register your child based on the grade level( s) he will be entering in the fall of 2017.
Online www. isd622. org / ce Click“ Register Online”
Phone 651-748-7435 Have credit card & class info ready
Fax 651-748-7497 Send complete registration form
Mail Community Education – Youth 2520 E 12th Ave North St. Paul, MN 55109
Registration Form for Youth Enrichment and Swim Lessons( Adventure Connection and Summer EPIC are online registration – call for assistance)
PARENT / GUARDIAN NAME: HOME PHONE:()__________________ ____ CELL:() STREET ADDRESS: CITY: STATE: ZIP:
EMAIL ADDRESS:
By giving us your email we can notify you of program changes, cancellations, and new programs that will interest you and your family. Your email address will not be shared with any other organization. You will not be spammed.
EMERGENCY CONTACT NAME / RELATION( different from above): EMERGENCY CONTACT PHONE:() WHERE WILL YOUR CHILD BE GOING AFTER CLASS?( Youth Enrichment Only)
Check this box to opt out of program updates via email
PICKED UP BY ADVENTURE CONNECTION WALKING HOME
CLASS # PARTICIPANT( FIRST, LAST) M / F |
DATE OF BIRTH |
CLASS NAME |
COST |
Special Needs Note: For optional summer programs we do not have access to medical records or supplies kept in the nurse’ s office and our ability to provide support is limited. If you have any special needs or health concerns that would impact your child’ s participation in this activity, please email apolos @ isd622. org or call 651-748-7432 no later than one week before the class begins.
TOTAL COST
I HAVE READ, UNDERSTAND, AND AGREE TO THE COMMUNITY EDUCATION POLICIES AS FOUND ON WWW. ISD622. ORG / CE
PARENT / GUARDIAN SIGNATURE: PAYMENT INFORMATION:
MASTERCARD VISA DISCOVER CHECK: # __________( Payable to“ District 622”) CARD NUMBER: ___ ___ ___ ___- ___ ___ ___ ___- ___ ___ ___ ___- ___ ___ ___ ___ EXP. DATE: ___ / ___
SIGNATURE: DATE: 2