LYSANDER PROGRAM REGISTRATION
INFO
All programs are on a first come, first served
basis. You must register & pay
before attending any program. Credit
card minimum charge is $10.00 and to cancel out of a program that you have charged
– there is a $10.00 Administrative Fee. Bounced check fee is $20.00. Full
refunds are given if we cancel the
class. Refund - minus
a $5.00 administrative fee (per child) until after 1st class. Register by (1) Phone - 635-5999 - if using a
credit card, (2)
In Person, (3) By mail to
LYSANDER PROGRAM REGISTRATION FORM
Participants Name:
Age:
M/F:________________ Birthdate
Phone
(w): (h)
Address:
City: State:___________________Zip:___________
Program Name:__________________________________Session:_____________
Fee:
Program Name: Session: Fee:
Program Name: Session: Fee:
I am aware of the risk involved in the program(s)
being registered for and warrant that I am/my child is in good physical
condition. I also understand there is no
medical insurance included as part of the programs. I’ve read and understand the registration policies.
Do you give permission to use any pictures taken in
the newspaper or on our web site? YES or NO (circle one)
**Participant or Parent Signature**
~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
Credit
Card information - must be filled out in order to process.
MC ___VISA Expiration date:________________________
Card #:
Amount to be charged______________
Card Holder's Name:____________________________________________________
Card Holder's Signature:__________________________________________________
If printing and mailing registration form
TTTTTTTTTTTTTTTTTTTTTT OFFICE USE ONLY TTTTTTTTTTTTTTTTTTTTTT
Check: Cash: Charge Receipt______________
Date Received: Amount Received:_____________________
Authorization
#:
Reference #:___________________