Club Registration Form

Student Name *

First Name Last Name

Birth Date *

Month Day Year

Gender

Parent Name *

First Name Last Name

Parent E-mail

Parent Phone Number

Area Code Phone Number

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

I grant permission to Freedom Classical Academy to use my child’s image (photographs and/or video) for use in school media publications I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image. Please select option for the way your child will get home after club.

Agree Walk/bike Carpool Parent/Guardian

Club Selection

Kpop Social Club - Starts 3/27/20 (Fri 3:15-4:15 Rm 24) 6 weeks $ 21.00

Just a safe place to get to know other kids with the same interest in music!

Stem Club - Starts 4/1/20 (Wed 3:15-4:45 Simons Rm 11) 6 weeks $ 25.00

Karate - Starts 3/25/20 (WED 3:25-4:25 GYM) 7 Weeks $ 80.00

Dance Club - Starts 3/23/20 Two days a week (Mon & Tues 3:25-4:30 GYM) 6 weeks long all grades invited $ 45.00

Coding Club - Starts 3/27/20 (Fri 3:30-4:30 Mr. Wong's Rm 37) 3-8 grade 7 weeks $ 20.00

Craft & Crochet - Starts 3/19/20 (Thurs 3:15-4:15 Mrs. Crosby Rm 22) 3-8 Grade 8 weeks $ 15.00

Total $ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

CLUB REGISTRATION IS OPEN FOR 4th QUARTER

Club Registration Form