NORTHERN STAR SKATING   
TOT Skating Instruction      
APPLICATION


NAME________________________________________________

ADDRESS_____________________________________________

TOWN_______________________STATE________ ZIP CODE_________
                       
TELEPHONE_____________________________

AGE________ BIRTHDATE_____________________

EMAIL ADDRESS________________________________________

Any learning differences or physical limitations we      
should know about ? ________________________________________
_____________________________________________________

                                          
                                   
                                                                                                                                             

                                                                          TOT SKATING                          amount paid
              
Session I      Wednesday 9:30- 10:30 am      September 29- November 17, 2010          150.00 ____________
                                                                     
Session II     Wednesday 9:30- 10:30 am      December 1, 2010- February 2, 2011         150.00 ____________
                                                                      no class 12/22 or 12/29
Session III    Wednesday 9:30- 10:30 am          February 9 - April 6, ,2011                       150.00 ____________   
                                                                               No Class Feb 22

                                                                   
                                                      Each  Tot   Session  is 8 weeks long



                DROP OFF TO MANAGER IN FRONT OFFICE OF HOBOMOCK ARENAS  or mail to
                                 Hobomock Arenas, 132 Hobomock St,. Pembroke. MA 02359

                             Attention:     Northern Star Skating Institute ----- Debbie Johnson