Parents First Name:
Parents Last Name:
Students First Name:
Students Last Name:
Age:
Male Female
Address:
E-mail:
Phone #1:
Phone #2:
Appointment Preference:
Students 3 to 5 years:
Monday 5:15 pm Wednesday 5:15 pm
Tuesday 5:45 pm Thursday 5:45 pm
Students 6 to 14 years:
Monday 6:00 pm Monday 6:30 pm
Tuesday 6:00 pm Tuesday 6:30 pm
Wednesday 6:00 pm Wednesday 6:30 pm
Thursday 6:00 pm Thursday 6:30 pm
Saturday 10:00 am
Students 15 and up:
Monday 7:00 pm Tuesday 7:00 pm
Wednesday 7:00 pm Thursday 7:00 pm
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