Students' Name: First, Middle, Last
Students' Age/Birthday
Students' Grade in School
Parents' Name
Address
Home Phone
Cell Phone
Email Address
Students' Interests
Please enter below, 3 different days and 3 different times which will fit into your schedule.
The registration fee is $100. Please make checks payable to "Carla Breaux" or pay online using Zelle.
When you click "Submit", the registration form will go directly to my email.
Please submit Form and Fee by August 5, 2025. Remember a time will not be assigned until both are received.