Registration Form 2008

 

 
       
Student's name___________________________ Birthdate __/___/___ Grade ___ School ___________
Student's name___________________________ Birthdate __/___/___ Grade ___ School ___________
Address ____________________ City ____________________________ Zip ______________
Home phone ________________ Alternate phone______________________ Today's Date________________

 

Day of Class Name of Class
Fee

#of
students

 Subtotals
         
         
         
         
         
 
Total =
 

 

Please return the registration form with a check
payable to Tim Baker.
Mail to: Post Office Box 801
Porterville, California 93258

or drop it off at the ImagineU Children's Museum


For more information contact: Tim Baker at (559) 793-0530 or by email: scidip@ocsnet.net.

 

_______________________________
Signature of sponsor