IMAGINATION PLACE - Register Now!

Below is a form you can fill out to register for Fall 2010 classes.

**Please be sure to select your preferred tab for Fall.**

You will need to register infants separately as siblings. There will be no charge for infant siblings as long as he/she is 8 months or under and accompanying a registered sibling.

Payments are made through PayPal. Please note, you ARE NOT required to have a PayPal account. Just follow prompts for payment.

* Your First Name:
* Your Last Name:
*Mailing Address:
*City:
*State/Province:
*Zip:
*Phone:
Other Phone:	Type (work, cell, etc):
*Email:	Contact Preference:

Registrants

	First Name	Last Name	Date of Birth (mm/dd/yy)
Registrant #1
Registrant #2
Registrant #3

Class 1^st Choice

Location:	Class Type:

*Class:
<Select Location and Class Type first>

Class 2^nd Choice — Please select a second class in case your first choice is unavailable.

Location:	Class Type:

Class:
<Select Location and Class Type first>

Comments:

How did you hear about us:

By submitting, I agree to all terms and conditions

* - Required information.

Class 1st Choice

Class 2nd Choice — Please select a second class in case your first choice is unavailable.

Class 1^st Choice

Class 2^nd Choice — Please select a second class in case your first choice is unavailable.