Course Selection Form
LCCA After School Program
Student Name
First Name
Last Name
Class Selection
Art - Grades 1st - 3rd (max 25)- Wednesday 4:00pm - 4:30pm
Art - Grades 4th and 5th (max 25) - Wednesday 4:30pm - 5:00pm
Art - Grades 6th - 8th (max 25) -Thursday 4:00pm - 5:00pm - Mrs . Combs
Readers Theater Grades 1st - 5th (max 25) - Tuesday 5:00pm - 6:00pm - Ms. Windham
Trumpet Grades 6th- 8th (max 15 - Ensemble Class) - Friday 4:00pm - 4:30pm - Mr. Levy
Violin Grades 6th - 8th (max 15 - Ensemble Class) - Friday 4:30pm - 5:00pm - Mr. Levy
French Horn Grades (Max 15 - Ensemble Class) 6th - 8th - Friday 5:00pm - 5:30pm - Mr. Levy
Beginning Guitar (max 15 - Ensemble Class) - Friday 6:00pm - 6:45pm - Mr. Levy
Beginning Piano (max 10 - NO CLASS - Individual lessons)
Beginning Voice (max 8 - NO CLASS - Individual lessons)
Grade Level
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Name
First Name
Last Name
Parent/Guardian hone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Student Signature (if able)
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Parent Signature
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: