Mid-Prairie – JULY $370

Class Details

Saturday, July 18 - Wednesday, July 29

Class Times

July 18-29th (10 days!)
Everyday 8-11am; No Class on Sundays
Drives completed by July 29th

Class Location

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Class Registration Form

Spaces

Student First Name *

Student Last Name *

Student Middle Name

Student Preferred Name

Student Date of Birth (MM/DD/YYYY) *

Student Street Address *

City/Town *

State *

Zip Code *

Student DL No./Permit # (Not required)

Student Cell Number

Name of School *

Primary Email Address *

Parent Cell Number *

Parent First and Last Name *

Work or Home Number

Primary Doctor *

Primary Doctor Phone Number *

Preferred Hospital

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