Shoreline Soul Kids Registration Form

2016-2017 “SHORELINE SOUL - KIDS!” REGISTRATION FORM

Grades 4-8

I AM REGISTERING FOR:

(Please check which applies)    BRANFORD: ­­­­_____  MADISON:_____

Name:______________________________________________________

Address:____________________________________________________

City/State/Zip:________________________________________________

Telephone: (Preferred) ________________(Alternate)_______________

Email (Please print CLEARLY):_________________________________

Grade:_____

If you are registering more than one person, please provide this information for each.

If you are registering by phone and get voice-mail, please provide the above information.

Make checks payable to Shoreline Soul and send to Shoreline Soul, 54 Ken Rose Terrace, Westbrook, CT  06498

No refunds after workshop begins. Credit towards a future workshop.