ACED Online Class Registration Form
Summer 2008


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

Orchids One-on-One

Tour: 4 PM | Class: 9 - 10:30 AM

Tour: June 3 | Classes: June 7, 14

 

 

$6

Tea for Two for Women/Mixed Couples

1 – 2:30 PM

A: August 2 (Ladies)      B: August 9 (Mixed)

 

$6/couple

Gone Fishin' (Please provide T-Shirt size )

6 – 8 PM

A: May 12, 14, 19, 21  B: May 13, 15, 20, 22

 

$8

Starlight Theatre

7:30 PM

A: HS 7/16  B: Music Man 7/29  C: Fiddler 8/14

FREE

"Cositas"

10:30 AM - NOON

June 14, 21, 28

 

 

$6

Water Aerobics

A: 1 - 2 PM  B: 3 - 4 PM

June 1, 8, 15, 22, 29 & July 6

 

$10

Court and Lawn Games 2 - 3 PM June 1, 8, 15, 22, 29 & July 6     $10
Awakening the Artist Within 10:30 AM - NOON June 14, 21, 28     $6

Shatto Farm

10:30 AM

July 26

    $6

To Market, to Market

9:00 AM - NOON

A: Lee's Summit, July 12   B: Brookside, July 19

 

 

$6

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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