Starting Friday September 7, 2007

Registration form: Please call Sandra 704-875-1147 or email slselling@yahoo.com

to reserve your spot and bring completed registration form with payment the first day of class. Circle which class time is preferred- there are three payment options.

• 2:15-3:15 8-11 year olds (ages flexible)
• 3:25-4:25 5-7 year olds (ages flexible)
• 4:35-5:35 12 and up (ages flexible)

Child’s..name:……………………Parents’..names:……………………………………………

Mailing address:………………………………………………………………………………….

City:………………………………………………………………………....Zip…………………

Email address……………………………………………………………………………………

Home ph. …………………………………………..Day ph:…………………………………..

Child’s grade……………………………..…D.O.B:……………………………………………

Check #.................................................Amount: $...........................................................

Make checks payable to Explore! and write your child’s name on the bottom.

-------------------------------------------------------------------------------------------------------------------

Or Please charge my credit card for the amount of $91.00

Your credit card statement will read Explore CLC as the vendor.

Credit card #.................................................................exp.date:………………………….

Full name on Card………………………………………………………………………………

-------------------------------------------------------------------------------------------------------------------

Or I would prefer Checking Account Draft

One draft of $91.00

Routing No:………………………………….…........Account#:………..………………………………….

-----------------------------------------------------------------------------------------------------------------

Questions? Contact: Donna Geraci DGeraci@explorebeyondschool.com