Currently classes rotate between Midlothian Pk. Dist .and Palos Courts - schedule on first day of class

Student’s Name_______________________________

Address_____________________________________City_________________

State_________Zip_________

Phone  (___)____________________________               Parent's Email____________________________________

Parent’s Name____________________________

Alternate Phone? __________________________  circle one:    cell     work     other

Pants size_____________

Top size____________

Shoe size _____________                                Does you child have allergies?  ____yes   ___no  To what? _________________

Class: circle       baton/colorguard/flags (ages 8 and up)    or    baton/poms  (ages 5-7)    other (specify)_______________

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FOR STAFF USE ONLY

(Circle)

Location:   MIDLO/PALOS   Other Specify_________________

*One time yearly dues/fee: ($135)   ____________ 

Total due:               $135___________

**Total Paid:        __________________

TODAY’S DATE: _____________________

* All members participate in fundraising during the year also

**No one can attend any classes unless fees are paid in full

I am enrolling my child(ren) in the classes I have circled above.  I accept full responsibility for any injuries or mishaps.

Parent’s signature________________________________________________________

Mail to: Elaine Jones 2282 W. Nichols Arlington Heights, IL. 60004 847-342-1971  (Form and fees can be brought in person on the first day)

Note: If you choose to mail in this form and form/dues are not received by the start of class you will have to pay all fees in order to attend class.