Group On-Line Registration Form

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Music Ministry

ON-LINE GROUP CLASS REGISTRATION FORM

Final placement is up to the discretion of the instructor; class availability is limited and subject to change.

Questions? Call: (352) 795-CCA2 (2222) or e-mail Stacy at stacy.mason@gulftolake.com

Students Full Name:
*
Age:
*
Date of Birth:
*

Male
Female
Street Address #1:
*
Street Address #2
City State Zip Code
*
Parent(s)/Guardian(s) Name(s) (if applicable):
*
Home Phone:
*
Work Phone:
*
Cell Phone:
*
e-mail address:
*
Church Attend if applicable:
*
Student's School Name:
*
Grade:
*
Proposed Study (see side margin for selections):
*
Number of years/months of previous experience:
*
CCA Handbook (choose one):

I will pick up a copy of the student handbook at CCA office.
I will Download a copy of the student handbook online (see side tab)
I will have the CCA office mail me a copy of the student handbook.
Security code:
*
Do not enter anything in this field:

* indicates a required field

Please choose a class code (i.e., HHH1) to complete the registration form in the specified box:

SUNDAYS
DID1
Dramatic Interpretive Dance
for Kids (Age 5-7)
2:45-3:30 PM

HHH1
Hallelujah Hip Hop 1
(6th Grade-Adult)
3:45-4:45 PM

MONDAYS
CM34
Coordination/Movement
(Age 3-4)
3:15-4:00 PM

DID2
Dramatic Interpretive Dance
for Kids (Age 8-11)
4:00-4:45 PM

IS1
Interpretive Signing 1
(Age 12-Adult)
4:45-5:30 PM

IS2
Interpretive Signing II
(Age 12-Adult)
6:45-7:30 PM

IS3
Interpretive Signing III
(Age 12-Adult)
7:30-8:15 PM

WEDNESDAYS
HHH2
Hallelujah Hip Hop 2
(6th Grade-Adult)
3:30-4:30 PM

LHH
Lyrical Hip Hop
(6th Grade-Adult)
4:30-5:30 PM

Tuition is due in full. INSTALLMENT PAYMENTS ARE NOT AVAILABLE FOR ANY GROUP CLASS STUDY!!!

Please make check payable to Gulf To Lake Church, Memo: CCA.

Mail checks to:
Gulf to Lake Church
Attention: CCA Admnistrator
1454 N. Gulf Avenue
Crystal River, FL 34429

Gulf To Lake Church

1454 N. Gulf Avenue

Crystal River, FL 34429

Contact: 352-795-CCA2 (352-795-2222) or e-mail stacy.mason@gulftolake.com

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