Summer Speech Registration Form

Name: _______________________ Phone Number: ______________________

Address: _______________________________________________________________

_______________________________________________________________________

Emergency Contact: ____________________ Phone: _________________________

I, __________________________________________________, am registering my child

___________________________, for Summer Term Speech. I understand that a fee of
$150.00 is due along with the submission of this form by Friday, May 21st. I understand
that the class will meet from June 10th through June 30th from 8:00 a.m. to 12:00 each
weekday. I understand that this fee is nonrefundable, unless the course is cancelled due to
lack of enrollment.

All school rules apply to the summer session including prompt attendance, dress code
expectations, and the behavioral code of conduct.

Signed: _________________________________________________ Date: _________

Fee Attached: _______ Cash _______ Check # _______