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Student Registration Form

You are registering for:

Smithfield Elementary - Winter 2017- Session #3

Dates: Tuesday 1/30, 2/6, 2/13, 2/20, 2/27, 3/6

Price: $99.00

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  




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