ACED Online Class Registration Form
Summer 2007

Name:  Address: 
Phone Number:    City:  State:  Zip: 
Have you attended ACED classes before?    Yes    No Is this a new address?         Yes    No
 
List a person to contact in case of an emergency during a Saturday morning class.

Name:            Relationship: 

Phone Numbers) of Contact:
Home:          Work:         
Pager:          Cell:           

Current medications or special accommodations:

 

How to register for classes

1. Complete all information above.

2. Please check the class or classes of your choice:

Class

Time

Dates

A

B

C

Fee

Self Defense for Men

9:00 AM - NOON

July 7

 

 

$10

Tea for Two for Women

1:30 – 3:00 PM

A: August 18      B: August 25

 

$6/couple

Gone Fishin' (Please provide T-Shirt size )

6 – 8 PM

A: May 14, 16, 21, 23  B: June 4, 6, 11, 13

 

$8

Starlight Theatre

7:30 PM

A: Burn - June 14     B: Wizard - July 24

 

FREE

Volleyball

2 – 3 PM

June 3, 10, 17, 24 & July 8, 15

 

 

$10

Water Aerobics

A: 1 - 2 PM  B: 3 - 4 PM

June 3, 10, 17, 24 & July 8, 15

 

$10

Horseback Riding

 Please sign up to be placed on the waiting list. Dates and location are to be determined. Do not send class fees for this class.

To Market, to Market

9:00 AM - NOON

A: Lee's Summit, July 21   B: Kansas City, July 28

 

 

$10

3.  Fees are $6 - $10 depending on the choice of class or classes. If you are submitting this form on-line, then you need to mail your check with the correct amount to:

Wendy Seelbinder
ACED Program
UMKC Institute for Human Development
2220 Holmes St, Room 340
Kansas City, MO 64108.


All checks should be made payable to:
UMKC Institute for Human Development

DO NOT SEND CASH!!!

Printable Registration Form (You will need Adobe PDF Reader to view/print the form.

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