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2. First Name*
3. Last Name*
5. Parent / Guardian Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
14. Parent/Guardian Phone Number*
16. School
17. Age*
18. Email*
20. Session Selection: *

    Please select the session you wish to attend

    1. Session 1: Tuesday and Thursdays, January 11 - 27, 2022
    2. Session 2: June 2022 - Dates TBD
22. Acceptance:

    You will receive confirmation and specific information approximately 14 days prior to the start of the session For further information, please contact Community Programs at 661/267-5450.

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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

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