WCP/BHCT Class Registration Form

Visit http://www.wcpbhct.org/take-classes for the current list of classes.

Need more information? Please contact us at 319.235.0367 or info@wcpbhct.org

Participant's First Name

This is a required question

Participant's Last Name

This is a required question

Participant's Age

This is a required question

Parent's Name

(if participant is 18 years old or younger)

This is a required question

Email address

This is a required question

Phone

include area code, ex. 319-235-0367

This is a required question

The phone number provided above is my

This is a required question

Street address

This is a required question

City

This is a required question

State

This is a required question

Zip

This is a required question

Class Title

This is a required question

Session Dates

This is a required question

List any special accommodations or assistance you need in order to participate in this class

This is a required question

Is the participant a current season ticket "member"?

This is a required question

Payment Arrangements (payment is due 1 week before class begins)

Please call me so that I can provide credit card information
I am mailing a check to: WCP/BHCT | 224 Commercial St. | Waterloo, IA 50701
I will stop by to make payment. (Office is located at 224 Commercial Street in Waterloo. Hours are Tuesday-Friday, 8 AM - 6 PM)

This is a required question