Blast from the Past    2008

           Child's Name     Age

           Parent's Name

           Address
        
           City  State  Zip

           Phone Number  Email Address

           Choose morning (9:30-11:30)     OR   afternoon (1:00-3:00) session 
             
            If you are not attending all sessions, please list the sessions that you will miss.
         July 3rd     July 10th     July 17th     July 24th    July 31th    August 7th
           

            If you have not received a confirmation email within one week, please call 740/387-4255 to
            confirm your registration.