2020 Tampopo Kai form test page Tampopo Kai Registration Form Konnichi wa, welcome to Tampopo Kai registration! Please fill out all fields on the registration form and photo release waiver. Only 1 registration is necessary per family. One payment per family. Your registration is complete once payment has been received, so please don't forget to make your payment. We are looking forward to seeing you for a fun time in Tampopo Kai! Parent Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Email* Name of Student #1* First Last Date of birth of Student #1* MM DD YYYY Name of Student #2 (if applicable) First Last Date of birth of Student #2 (if applicable) MM DD YYYY Are you a JASC Member?*YesNoSpring Session-II*Note: 5-session payment option is for current session only, classes do not carry over to the next session. Unable to join for the full session? Pay-per-class is available! For any questions please contact: email@example.com. Monday, 10:00-11:00am, 5 years and under, Member $75/5 weeksWednesday, 10:00-11:00 am, 3 years and older, Member $75/5 weeksSingle class Member Monday $18Single Class, Member Wednesday $18Both Monday & Wednesday - Member $36Spring Session-II*Note: 5-session payment option is for current session only, classes do not carry over to the next session. Unable to join for the full session? Pay-per-class is available! For any questions please contact: firstname.lastname@example.org.Monday, 10:00-11:00 am, 5 years and under, Non-member $100/5 weeksWednesday, 10:00-11:00 am, 3 years and older, Non-member $100/5 weeksSingle Class, Monday Non-member $22Single Class, Wednesday Non-member $22Both Monday & Wednesday Non-member $44Total $0.00 Photo Release FormPlease check the boxes* I hereby authorize Japanese American Service Committee (“JASC”) and its representatives to use, print, publish, or display my picture and/or my name for public relations or other purposes to benefit the JASC and its programs. I have read and understand this consent form. I also understand that I can withdraw my consent at any time. Child's Name* First Last 2nd Child's Name (if applicable) First Last Authorized Representative*Your typed name serves as your signature on this form. First Last Relationship*ParentLegal GuardianDate* Date Format: MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.