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Registration Form

DARIEN FENCING CLUB FOR KIDS
REGISTRATION FORM – 2017 WINTER/SPRING CLASS
To hold your place, please fax registration to (203) 539-6359
or mail with payment to Armonk Fencing Club, 5 Leatherman Court, Armonk NY 10504
Fencer’s Name __________________________________________
Date of Birth ____________Grade ______ Male ___Female ________
Name of Parent/Guardian __________________________________
Address _______________________________________________
_____________________________________________________
Telephone(Home)________________________________________
Parent Cell Phone(s) ______________________________________
Email address __________________________________________
Right Handed or Left Handed (circle one)

 

Membership Type:

Semester (19 Weeks) $1,520 _____   Monthly (4 weeks) $360 __________

Class: 4:00 PM– 5:30 PM

 

Payment Method:
Cash, or Checks: Make checks payable to Darien Fencing Club
Checks may be mailed to 5 Leatherman Court, Armonk NY 10504
Credit Cards accepted (a 3% processing fee will be added)
Name on Card _____________________________Card type ______________
Card number ______________________________ Exp. Date _______________
Security Code (last 3 digits on back of card) ___________

 

A Waiver of Liability is Required for participation (see next tab)
Please contact us in advance of participation if your child has any special needs
Tel: (203) 539-6359 Fax: (914) 307-1900
info@darienfencingclub.com

 

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