Please PRINT, complete, and return this form with check or payment information to:
Global Source Education: PO Box 11316, Bainbridge Island, WA 98110
or FAX to 206-780-5797
Farm Hands Afterschool Program Tuition Session 1: January 11-February 11 (this session has been cancelled) Session 2: February 22-March 25
Option 1: Mondays & Wednesdays, 2:30-5:00 Option 2: Tuesdays & Thursdays, 2:30-5:00
$5/Day
or $35/session
Farm Hands, extended care option (5-5:30p)
$35
Global Source Membership/Contribution
$_______
Tax Deductable Contribution to Global Source Education
$_______
Total Amount Due
Date of Registration
Name (First – Last)
Child/Parent
Mailing Address
Day Phone
E-Mail
School/Organization
Grade Level
Notes
You can register by phone during office hours at 206-780-5797
Please make checks payable to: Global Source Education
Credit Cards (Visa or MasterCard) accepted
Credit Card Information MasterCard
Visa Exp Date ____/____
Credit Card Number __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __