Participant Information

Name*:

Age*:

Cell Phone:*

Email:*

Address:*

City:*

State:*
---IllinoisWisconsin

Zip:*

Class:*
---Class AClass BClass C

Students must attend ALL three class days.

Participant 2 Information

Name:

Age:

Participant 3 Information

Name:

Age:

Participant 4 Information

Name:

Age:

If any participant above is a minor and the parent or guardian is not registered with them for a class please fill out the following fields.

Parent Name (if under 18):

Cell Phone: