To Register:

Name of Participant *
Name of Participant
Address *
Address
Phone Number Best to Reach You: *
Phone Number Best to Reach You:
Secondary Phone Number:
Secondary Phone Number:
Date of Birth: *
Date of Birth:
By checking the box below, I certify that I have read and agree to the above stated policies. *
Date *
Date
Please note that a $30 fee will be assessed for any returned checks.
Please indicate here if you are signing up for less than a full session or if you have any other special circumstance to note.

To Pay:

To pay via check, please make your check payable to the order of Josephina Gasca and mail to:

1213 Washington Street, Bath, ME  04530

OR

To pay via PayPal, please transfer monies to Josephina.Gasca@comcast.net via your PayPal account.