Junipero Serra School
Afterschool Class Registration Form
Please Print this form and return it to the JSS Office by the day before the first day of class to ensure a space, or bring to the first class on a space available basis.
Snack will be provided.
All fees are non-refundable and due at the time of the class.
Make checks payable to Cynthia Lorence.
Name ________________________________________________
Grade _______
Address ______________________________________________
_____________________________________________________
Phone _______________________________________________
Emergency Contact ____________________________________
Emergency Contact Phone ______________________________
Please indicate the class(es) you are registering for:
__ Desert Habitats...$55.00
__ Butterflies...$55.00
__ Harvest Gardening...$55.00
Total Enclosed: _________________