Community Ed Classes - Registration Form

Note: Employees, please email for current employee pricing.

Participant's Information Name * Participant's Age * Under 1818-5960+ (10% discount applies)

Minors may be required to provide parental consent prior to participating in a class.

Age *Name of Legal Guardian *

Home Phone Number *Work/Cell PhoneEmail Address *

Class Information

Course Title	Time	Fee
	Discount	$
	Total	$
1:		$
2:		$
3:		$

Add Course +

Credit Card Billing Information Card Holder First Name *Card Holder Last Name *Billing Address *City *State *Zip *Credit Card Number * Expiration Month * Expiration Year *

Edgerton Hospital And Health Services

Community Ed Classes - Registration Form