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

Nature Printmaking 10:00 AM June 9     FREE
Shatto Farm Tour 10:30 AM July 28     $ 4

Music Improvisation

9 AM - 10 AM June 30     $ 4

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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