Venice Auxiliary Course Registration Form

Student Registration Form

Fill out the form carefully for registration
Courses
Select Your Class Month
How did you hear about us?
How many people will you be registering?
The cost is $40 per person
1st Student’s Name

First NameMiddle NameLast Name
1st Student’s Birth Date

MonthDayYear
1st Student’s Gender
1st Student’s Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
1st Student’s E-mail
example@example.com
1st Student’s Phone Number
Format: (000) 000-0000.
2nd Student’s Name

First NameMiddle NameLast Name
2nd Student’s Birth Date

MonthDayYear
2nd Student’s Gender
2nd Student’s Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2nd Student’s E-mail
example@example.com
2nd Student’s Phone Number
Format: (000) 000-0000.
3rd Student’s Name

First NameMiddle NameLast Name
3rd Student’s Birth Date

MonthDayYear
3rd Student’s Gender
3rd Student’s Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3rd Student’s E-mail
example@example.com
3rd Student’s Phone Number
Format: (000) 000-0000.
4th Student’s Name

First NameMiddle NameLast Name
4th Student’s Birth Date

MonthDayYear
4th Student’s Gender
4th Student’s Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
4th Student’s E-mail
example@example.com
4th Student’s Phone Number
Format: (000) 000-0000.
Should be Empty: