Classes rotate between Midlothian Pk. Dist .and Palos Courts - call for schedule

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 _____________

Class circle:   baton         colorguard/flags         poms    other (specify)_______________

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FOR STAFF USE ONLY

(Circle)

Location:   MIDLO/PALOS   Other Specify_________________

Poms Dues/Fee: ($40)   ____________ 

Pom Outfit ($45)         _____________

Total due:               $85___________

*Total Paid:        __________________

TODAY’S DATE: _____________________

*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

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.