LEARNING AT HOME REGISTRATION FORM
Postmarked one week in advance of the workshop


Name of Teen:_________________________________________________________

Name of Teen:_________________________________________________________

Name of Parent:_________________________________________________________

Address:_______________________________________________________

_______________________________________________________________

Phone number:__________________________________________________

Email address of Parent:__________________________________________________

Date of workshop: _______________

Location of workshop:_______________________________

Each Teen Registration is $20. Each teen must attend with a parent or be registered with another adult.

Parents attend free of charge.


Amount enclosed: ___________

Make check payable to Barbara Mesh and mail to:
Barbara Mesh 
2030 Capps Road
Lake Wales, FL 33898