Adult Registration Form Online Enrollment Form Adult's First Name * Adult's Last Name * Date of Birth * Desired Date of Class Email * How many hours of instruction * 1 Hour ($100.00) 5 Hours ($480.00) 10 Hours ($900.00) Home Phone Cell Phone End Section Address * Address Line 2 City * State * AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip Code * Gender Male Female Comments Upload Photo ID (optional) I have read and agree to the school policies*. If you are human, leave this field blank.