STUDENT INFORMATION STUDENT'S NAME ___________________________________________________ DATE OF BIRTH: ______________________ AGE: _______________ PARENTS/GUARDIAN: mother: __________________________ father: ______________________ ADDRESS: ________________________________________________________________________ PHONES: home: ___________________ Cell _________________ Cell _____________________ EMAIL ADDRESS: ____________________________________________________________ ________________________________________________________________ CLASS ATTENDING: ________________ DAY(S): _________TIME: ________ HOW MUCH EXPERIENCE DOES THE STUDENT/PARTICIPANT HAVE IN THIS TYPE OF CLASS? _________________________________________________________________________ COMMENTS / CONCERNS: _______________________________________________________ RULES AND CONDUCT: Please read Rules and Conduct document. Keep it for your referral. By signing below, parent (s) have read and agree with its terms. Parent or Guardian Signature: ________________________ Date: ___________