SSDA CLASS REGISTRATION FORM
Please follow the instructions carefully. Photo copy this sheet so that you can fill out one class registration form for each class. Please print legibly. Write a separate check for the TOTAL AMOUNT for each class and make it payable to the teacher. Mail class registration forms and checks to Michelle Shroyer, 706 Belt Court, Tampa, FL 33612-5717
| Name | |||
| Address | |||
| State | Zip | Day Phone | |
| Evening Phone | |||
| Class Name and # | |||
| Day and Time | |||
| Teacher’s Name | |||
| Class Cost $ | Supplies $ | TOTAL $ | |
| Name | |||
| Address | |||
| State | Zip | Day Phone | |
| Evening Phone | |||
| Class Name and # | |||
| Day and Time | |||
| Teacher’s Name | |||
| Class Cost $ | Supplies $ | TOTAL $ | |
| Name | |||
| Address | |||
| State | Zip | Day Phone | |
| Evening Phone | |||
| Class Name and # | |||
| Day and Time | |||
| Teacher’s Name | |||
| Class Cost $ | Supplies $ | TOTAL $ | |