Your Subtitle text
Student Registration Form

You are registering for:

Antioch Elementary - Spring 2018- Session #2

Dates: Tuesdays 2/20, 2/27, 3/6, 3/13, 3/20, 3/27

Price: $110.00

After submitting, you will be redirected to a PayPal payment screen to complete your registration.

Student Name:
School:
Program Day:
 Gender:
Date of Birth:
Parent/Guardian Name:
 Grade Level:
 Address:  
 City:  
 Zip Code:  
 Phone Number:  
 Email Address:  
Notes/Additional Information:  
 I have read the policies  




Website Builder