Please complete the following:   

Student's First Name   Student's Last Name

Nickname Sex:   Female    Male

Date of Birth   Age  

Academic School   Grade

Mother’s Name    Mother's Cell Phone

Father’s Name    Father's Cell Phone

Mailing Address

City   State   Zip   

Home Phone

Preferred Contact Email

Does your child take medication or have any medical, learning or other special considerations? Yes    No

If yes, what type(s) of medication?

How did you hear about us? Please check all that apply.  Word of Mouth    Former Student   Newspaper Ad    Other

Class Selection (birthday cut-off: must be required age by September 1st)

Six Week Saturday Session, June 20-August 1 (no class July 4)

______Ages 3-4          10am-10:30am           $55
______Ages 5-6          10:45am-11:30am    $65

.Tuition and Fees

Tuition
(Refund policy: 100% after first class, 50% after second class)

$25 Annual Registration Fee (new students)

Total

Full payment is due upon registration.
Please make check payable to Indiana University or ask for a form to pay by Credit Card. Payment must occur on or before the first day of class.

Checks can be mailed to:

Please email questions to swindell@indiana.edu.