Key West Lighthouse Museum - 938 Whitehead Street I would like to register my child for the week of: _____December 27,28,29 2006 _____January 3,4,5 2006. All classes will be held from 10 am –12:30 pm Student Info: First Name:____________________Last Name:______________________________ Age:____________ Grade:______School:___________________________________ Address:_______________________________________________________________ City:_________ State:______ Zip:_____________ Parent / Guardian Info: First Name:_______________________ Last Name:___________________________ Phone/Home:_______________ Work:_______________ Cell:__________________ Email Address:__________________________________________________________ Emergency Contact:____________________________________________________ Phone:_______________________Cell phone_______________________________ May we photograph your child for inclusion on our website: _____Yes _____No Method of payment: Check#:_______________________________Cash:____________________ Visa cc#___________________________________Expiration date:______________ Mastercard cc#_____________________________ Expiration date:_____________ AmeExcc#_________________________________Expiration date:_____________ Signature on card:______________________________________________________ Total paid:_____________________________________________________________ Each 3 day session is $75 10% off for KWAHS members. Payment is due on registration. Parents will be required to fill out a medical release form on the first day of class. We ask each parent to provide a snack sufficient for 12 students on a one time only basis. Suggested snacks: juices, fruit cups, cheese sticks, crackers, chips or homemade snacks. Thank you. Tuition includes all supplies. Space is limited to 10 students only per week Full refunds will be made only up until 7 days prior to session start date. No refunds will be given after this cut off date. Students will be subject to reprimand by KWAHS staff if he/she misbehaves while on the museum premises. Parents must accompany students in and out of the museum.