Power PE 103 Course Registration
REGISTRATION CLOSED FOR THIS SESSION For questions, text or call Coach Adam directly at 317.519.3076 or call our office at 713-501-6021.
Student #1 Information
The cost for Power PE $160.00 for the 6 week session. (12 classes) Mighty Tykes is $120.00.
Student Name
*
First Name
Middle Name
Last Name
Gender
*
Please Select
Male
Female
N/A
Age of Student
*
Please Select
5yrs
6yrs
7yrs
8yrs
9yrs
10yrs
11yrs
12yrs
13yrs
14yrs
15yrs
Select Class
*
Please Select
Power PE Mighty Tykes(5-7yrs) 10:30am - 11:30am
Power PE 102 (8-11yrs) 11:45am - 1:15pm
Power PE 101 (12-15yrs) 1:30 pm - 3:00pm
Student T-Shirt Size
Please Select
Youth Small
Youth Medium
Youth Large
Youth Extra Large
Adult Small
Adult Medium
Adult Large
Adult Extra Large
Student #2 Information
The 2nd sibling is $80.00 for any course.
Student Name
First Name
Middle Name
Last Name
Gender
Please Select
Male
Female
N/A
Age of Student
Please Select
5yrs
6yrs
7yrs
8yrs
9yrs
10yrs
11yrs
12yrs
13yrs
14yrs
15yrs
Select Class
Please Select
Power PE Mighty Tykes(5-7yrs) 10:30am - 11:30am
Power PE 102 (8-11yrs) 11:45am - 1:15pm
Power PE 101 (12-15yrs) 1:30 pm - 3:00pm
Student T-Shirt Size
Please Select
Youth Small
Youth Medium
Youth Large
Youth Extra Large
Adult Small
Adult Medium
Adult Large
Adult Extra Large
Student #3 Information
The 3rd sibling is $80.00 for any course.
Student Name
First Name
Middle Name
Last Name
Gender
Please Select
Male
Female
N/A
Age of Student
Please Select
5yrs
6yrs
7yrs
8yrs
9yrs
10yrs
11yrs
12yrs
13yrs
14yrs
15yrs
Select Class
Please Select
Power PE Mighty Tykes(5-7yrs) 10:30am - 11:30am
Power PE 102 (8-11yrs) 11:45am - 1:15pm
Power PE 101 (12-15yrs) 1:30 pm - 3:00pm
Student T-Shirt Size
Please Select
Youth Small
Youth Medium
Youth Large
Youth Extra Large
Adult Small
Adult Medium
Adult Large
Adult Extra Large
Parents Contact Information
Please provide your email for invoices and communication. Once you have completed this registration form an email will follow. IMPORTANT! registration is not complete until the invoice is paid.
Parent/Guardian Name
*
First Name
Middle Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I authorize The Black Tide Educational Guild to send me electronic communications through email and/or text communication.
*
Email
Text Message
Where did you hear about course?
*
Facebook
Light Homeschool Group
KACH Homeschool Group
Referred by Instructor
Word of mouth
Other
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