Parent Name *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Amount *

$25.00 gift certificate or toward scholarship fund

$50.00 gift certificate or toward scholarship fund

$65.00 (Deposit for foundation Level 1 & 2 classes)

$75.00 (Deposit for Level 3 classes)

$100.00 (Deposit for Level 4 & 5 classes)

$100.00 gift certficate or toward scholarship fund

$175.00 ( Class paid in Full for foundation Level 1 class)

$265.00 (Class paid in Full for level 2 class)

$275.00 (Class paid in Full for Level 3 class)

$330.00 (Class paid in Full for level 4 class)

$320.00 (Class paid in full for level 5 class )

Age group *

Foundation Level 1- ages 0-18 months

Level 2-ages 18 months -3yrs

Level 3 ages 3-5yrs

Level 4 or 5 ages 5-7yrs

Level 5 for ages 6 & 7yrs (for previous students only

Donation to our scholarship fund

Phone

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