Skokie Teen Registration January 12

Please select the class you wish to join*

01-12-26 (7pm-9pm) Skokie Teen Program

Parent/Guardian Name (First and Last)*

First Name (Student)*

Last Name (Student)*

DATE OF BIRTH (MM/DD/YYYY)*

City*

Street Address1*

Postcode / Zip*

Phone # (Student)*

Phone # (Parent)*

Email (Student)*

Email (Parent)*

Select*

Additional Discounted Services*

Online Written Permit Practice ($25)

Questions/Comments?