Pure Life Teen Summer Sessions 2018

Please print, file out and bring with you on June 6th.

 

Students First Name:                                                     Last Name:

Parent’s Name:

Address:

APT # or BOX #:

City:                                                                             State:

Zip:

School:                                                                            Grade:

What Instrument Do You Play?:

Do You Sing?:  

Parent’s Cell

Receive text msgs    YES       NO

Parent’s E-mail:

Student’s Cell:

Receive text msgs:    YES       NO

Student’s Email:

 

PARENT:

SIGNATURE:

DATE: