ÿþ<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3c.org/TR/1999/REC-html401-19991224/loose.dtd"> <HTML xmlns="http://www.w3.org/1999/xhtml"><HEAD><TITLE>Untitled Document</TITLE> <META http-equiv=Content-Type content="text/html; charset=iso-8859-1"> <META content="MSHTML 6.00.2600.0" name=GENERATOR></HEAD> <BODY> <table cellspacing=0 cellpadding=0 width=674 border=2> <tbody> <tr> <td align=center><h1>Lebanon Area Homeschoolers <br>Fine Arts Enrollment Form</h1></td></tr> </tbody> </table> <FORM action=faenroll-form-send.php method=post> <P><STRONG>FAMILY INFORMATION:</STRONG><BR></P> <TABLE cellSpacing=0 cellPadding=0 width=674 border=2> <TBODY> <tr> <td colspan=3>All fields in this section are required</td></tr> <TR> <TD width=242>Last Name:<INPUT tabIndex=1 size=21 name=lastname></TD> <TD width=216>Father:<INPUT tabIndex=2 size=22 name=fathersname></TD> <TD width=216>Mother:<INPUT tabIndex=3 size=21 name=mothersname></TD></TR> <TR> <TD colSpan=3>Address:<INPUT tabIndex=4 size=96 name=address></TD></TR> <TR> <TD colSpan=3>City,state,Zip:<input tabIndex=5 size=91 name=citystatezip></TD> <TR> <TD>Telephone:<input tabindex=8 size=22 name=phone></TD> <TD colspan=2>Email:<INPUT tabIndex=9 size=59 name=email></TD></TR> <TR> <TD>Cell Number:<input tabIndex=10 size=19 name=cell></TD> <TD colspan=2>Emergency Contact Name/Phone:<Input tabindex=11 size=31 name=emergency> </td> </tr> </TBODY> </TABLE> <br> <P><STRONG>CHILD/CLASS INFORMATION:</STRONG></P> <TABLE cellSpacing=0 cellPadding=0 width=674 border=2> <tbody> <TR> <td>Student's Name</td> <td><input tabindex=15 size=9 name=fastudent1></td> <td><input tabindex=16 size=9 name=fastudent2></td> <td><input tabindex=17 size=9 name=fastudent3></td> <td><input tabindex=18 size=9 name=fastudent4></td> <td><input tabindex=19 size=9 name=fastudent5></td> <td><input tabindex=20 size=9 name=fastudent6></td></TR> <TR> <td>Child's Grade</td> <td><input tabindex=21 size=9 name=fagrade1></td> <td><input tabindex=22 size=9 name=fagrade2></td> <td><input tabindex=23 size=9 name=fagrade3></td> <td><input tabindex=24 size=9 name=fagrade4></td> <td><input tabindex=25 size=9 name=fagrade5></td> <td><input tabindex=26 size=9 name=fagrade6></td></TR> <tr> <td bgcolor=#bbbbbb colspan=7> <p align=center><strong>Fine Arts Classes 9:00am-12:00 pm</strong><font face=italic> (Grades Birth through Adult)</font></p></td></tr> <tr> <td>1<sup>st</sup> Hr. 9:00</td> <td><input tabindex=27 size=9 name=fastudent1hr1></td> <td><input tabindex=28 size=9 name=fastudent2hr1></td> <td><input tabindex=29 size=9 name=fastudent3hr1></td> <td><input tabindex=30 size=9 name=fastudent4hr1></td> <td><input tabindex=31 size=9 name=fastudent5hr1></td> <td><input tabindex=32 size=9 name=fastudent6hr1></td></TR> <tr> <td>2<sup>nd</sup> Hr. 10:00</td> <td><input tabindex=33 size=9 name=fastudent1hr2></td> <td><input tabindex=34 size=9 name=fastudent2hr2></td> <td><input tabindex=35 size=9 name=fastudent3hr2></td> <td><input tabindex=36 size=9 name=fastudent4hr2></td> <td><input tabindex=37 size=9 name=fastudent5hr2></td> <td><input tabindex=38 size=9 name=fastudent6hr2></td></TR> <tr> <td>3<sup>rd</sup> Hr. 11:00</td> <td><input tabindex=39 size=9 name=fastudent1hr3></td> <td><input tabindex=40 size=9 name=fastudent2hr3></td> <td><input tabindex=41 size=9 name=fastudent3hr3></td> <td><input tabindex=42 size=9 name=fastudent4hr3></td> <td><input tabindex=43 size=9 name=fastudent5hr3></td> <td><input tabindex=44 size=9 name=fastudent6hr3></td></TR> <tr> <td bgcolor=#bbbbbb colspan=7><p align=center><strong>Fine Arts Classes 12:30-3:30pm </strong><font face=italic> (Grades 7<sup>th</sup> through Adult)</font></p></td></tr> <tr> <td>4<sup>th</sup> Hr. 12:30</td> <td><input tabindex=45 size=9 name=fastudent1hr4></td> <td><input tabindex=46 size=9 name=fastudent2hr4></td> <td><input tabindex=47 size=9 name=fastudent3hr4></td> <td><input tabindex=48 size=9 name=fastudent4hr4></td> <td><input tabindex=49 size=9 name=fastudent5hr4></td> <td><input tabindex=50 size=9 name=fastudent6hr4></td></TR> <tr> <td>5<sup>th</sup> Hr. 1:30</td> <td><input tabindex=51 size=9 name=fastudent1hr5></td> <td><input tabindex=52 size=9 name=fastudent2hr5></td> <td><input tabindex=53 size=9 name=fastudent3hr5></td> <td><input tabindex=54 size=9 name=fastudent4hr5></td> <td><input tabindex=55 size=9 name=fastudent5hr5></td> <td><input tabindex=56 size=9 name=fastudent6hr5></td></TR> <tr> <td>3<sup>rd</sup> Hr. 2:30</td> <td><input tabindex=57 size=9 name=fastudent1hr6></td> <td><input tabindex=58 size=9 name=fastudent2hr6></td> <td><input tabindex=59 size=9 name=fastudent3hr6></td> <td><input tabindex=60 size=9 name=fastudent4hr6></td> <td><input tabindex=61 size=9 name=fastudent5hr6></td> <td><input tabindex=62 size=9 name=fastudent6hr6></td></TR> <tr> <td bgcolor=#bbbbbb colspan=7>&nbsp</td></tr> <tr> <td>Class fees</td> <td>$<input tabindex=63 size=7 name=faclassfees1></td> <td>$<input tabindex=64 size=7 name=faclassfees2></td> <td>$<input tabindex=65 size=7 name=faclassfees3></td> <td>$<input tabindex=66 size=7 name=faclassfees4></td> <td>$<input tabindex=67 size=7 name=faclassfees5></td> <td>$<input tabindex=68 size=7 name=faclassfees6></td></tr> </tbody> </table> <P><STRONG>ENROLLMENT/CLASS FEES:</STRONG></P> <TABLE cellSpacing=0 cellPadding=0 width=674 border=2> <TBODY> <tr> <td>Fine Arts family fee $24.00 Per semester:</td> <td>$<input tabindex=69 size=8 name=fafamilyfee></td> <td align=center rowspan=3><P><font size=1>Class Enrollment is Accepted on a First-Come Basis<br><br> Class Fees are Non-Refundable </p>*Payment Options: Pay Full Amount at Enrollment or <br>Half at Enrollment and Ballance by 4<sup>th</sup> Session <tr> <td>Total Class Fees (if applicable):</td> <td>$<input tabindex=70 size=8 name=faclassfees></td></tr> <tr> <td><bold>Total Amount Due:</Bold></td> <td>$<input tabindex=71 size=8 name=fatotalfees></td></tr> </TBODY> </TABLE> <P><BR><INPUT tabIndex=72 type=submit value=Send> <INPUT type=reset value=Reset> </P></FORM></BODY></HTML>