Achieve Learning Center

Registration

Pre-registration with payment is required. Refunds will be issued only if the class is canceled. All classes are $500 per semester. Each class is limited to 8 children, so please register early.

Registration form


Child' name:___________________________________________

Date of birth:____________________

Parent(s) name(s):

(M)_________________________ (F) _______________________

Address:_______________________________________________

Home phone #:____________ Work phone #:__________________

E-mail address:_________________________________________


In case of an emergency, name and number of a person to contact:

Name:______________________ Phone #:__________________


Fall semester 2005 with preferred class, day, and time:

Class:____________ Day:____________ Time:________________

Class:____________ Day:____________ Time:________________

Class:____________ Day:____________ Time:________________

*For music class, please specify piano, violin, or viola.


Spring semester 2006 with preferred class, day, and time:

Class:____________ Day:____________ Time:________________

Class:____________ Day:____________ Time:________________

Class:____________ Day:____________ Time:________________

*For music class, please specify piano, violin, or viola.


Make checks payable to Achieve Learning Center and mail to:

Achieve Learning Center
234 Old Town Road
East Setauket, N.Y. 11733









Designed by Clara Tran
Prof. Thomas Krichel, LIS650 of Spring 2005
Palmer School of Library and Information Science @ Long Island University
Last updated March 5, 2005

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