PROGRAM APPLICATION
(All personal and medical information will be kept in strict confidence)


ONE APPLICATION PER PROGRAM, PER PERSON.

A CREDIT CARD INFORMATION FORM AND RELEASE OF LIABILITY WILL BE EMAILED TO YOU UPON RECEIPT OF THIS RESERVATION.  YOU WILL NOT BE REGISTERED FOR THE CLASS UNTIL WE HAVE RECEIVED THE RELEASE AND THE CREDIT CARD PAYMENT HAS BEEN PROCESSED.

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Please answer the simple math question below to submit the form.
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