2026 JCl Tai Chi Registration May-July Form 5 week

Tai Chi Class
Student Information
Student Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Registration fee is $40 per student.
Does the student have any disabilities, illness, medical conditions, personal problems, etc. that can affect his/her class?
Others
How did you learn about this course?

Other
Any additional comments or information you would like to share?
Student Signature
Date Signed

MonthDayYear
Date
My Products
prevnext( X )
Student enrolled
Teacher - Professor Joaquin Jackson - 5 Week course - Every Tuesday starting April 28 - May 26. $40 a student. Class time 10:15am - 11:45am.

$40.00 Quantity
Item subtotal:$0.00

Total

$0.00
Should be Empty:

Tai Chi Class