Small Engine Winter Club

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WHEN: Wednesdays, January 7- February 11
TIME: 3:45 pm-4:45 pm at Bus Barn
GRADES: 6th-8th Grade
COST: $120
CONTACT: Mr. Adam Cole, adam.cole@stonebridgeschool.com

PARTICIPANT INFORMATION

Participant #1 Name*

First Last

Participant #1 Grade Level*

Upper School 6th Grade

Upper School 7th Grade

Upper School 8th Grade

Participant #1 Date of Birth*

List of allergies or medical conditions for Participant #1, if applicable

PARENT INFORMATION

Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone #1*

Phone #2

Email*

Emergency Contact (Alternative)

Name*

First Last

Email*

Address

Street Address City State / Province / Region ZIP / Postal Code

Accident/Injury Release Agreement

Payment Option*

Bill me in FACTS (SBS students ONLY)