Jr. Ambassador’s Club Registration Form

I give permission for my child __________________________

                          Grade /teacher__________________________

Please check one the following:

_____  I would like to enroll my child in Session 1.

             Dates: Wednesday, Oct. 12, Oct. 19, Oct. 26, Nov. 2, Nov. 16, Nov. 30,

                         Dec. 7, Dec. 14

_____ I would like to enroll my child in Session 2.

            Dates: Wednesday, Feb. 1, Feb. 8, Feb. 15, Feb. 29, March 7,

                        March 14, March 21, March 28

Please check one of the following:

_____  I will pick my child up after each meeting in the lobby of CES

             at 4:00 pm.

_____  My child will ride the late bus from CES to the following address:

              ___________________________________________________

__________________________________________________________

__________________________                       ______________________

Signature                                                                e-mail

________________________                            ______________________

Home phone                                                          cell  phone

SIGN AND RETURN TO MS. BORGEN BY SEPTEMBER 30TH FOR FIRST SESSION.