REGISTRATION FORM | |||||
| IF COURSE IS CANCELLED DUE TO INSUFFICIENT ENROLLMENT, YOUR REGISTRATION WILL BE REFUNDED OTHERWISE, NO REFUND. |
Clip and mail to: ADULT EDUCATION CENTER | ||||
| Please enroll me in the following
course. (Check appropriate circle) O I have am Golden Age (no tuition enclosed). O I am enclosing my check, made payable to Henrico County Public Schools. | |||||
$ ____________ Tuition +$__________ Administrative fee (Administrative fee is $15 per person per class) |
+ $ ___________ Book + _______ Materials fee | = $ ____________ Total Payment | |||
|
_________ Course No. |
_____________________ Course Title |
_________________ School Date |
____________ Class Starts |
____________ Day of Week |
____________ Time a.m./p.m. |
| Name __________________________________ | Phone (home) ______________ | (work) _____________ | |||
| Home Address _____________________________________________________________________________________ | |||||
| Street | City | Zip Code | |||
|
Office use only: Receipt # __________ Check ________ Cash ________ Bill ________ Return ________ You MUST enclose a SEPARATE check and registration form for EACH class. | |||||