Enroll in Agganis Parent Class Your InformationParent First Name*Parent Last Name*Student First Name*Student Last Name*Address Line 1*Address Line 2City*State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZIP*Phone*Cell Phone*Parent Email* Permit # (optional)Choose any location and sessionChoose any location*Reading Office - 580 Main Street, Reading MAWilmington Office - 474 Main Street, Wilmington MAReading Office SessionsWednesday, July 26, 2017 - 6:00p to 8:00pWednesday, August 16, 2017 - 6:00p to 8:00pWilmington SessionsWednesday, June 21 2017 - 6:00p to 8:00pWednesday, July 12 2017 - 6:00p to 8:00pWednesday, August 2 2017 - 6:00p to 8:00pWednesday, August 30 2017 - 6:00p to 8:00pClass CostsDo you want to pay online or before the class?*Online now (PayPal or Credit Card}At the class (Cash or money order only!)Payment will be collected upon arrival.*Cash or money order only!Class cost per household $30.00 if your child is/or will be enrolled in the Agganis ProgramClass cost per household $89.00 if your child is not enrolled in the Agganis ProgramPayment Collected Online*PayPal or Credit CardClass cost per household $30.00 if your child is/or will be enrolled in the Agganis ProgramClass cost per household $89.00 if your child is not enrolled in the Agganis ProgramTotal $0.00 Number attending class*12Document Read and PrintDocument read and print. This document must be turned in on the day of your classREQUIRED:*This document must be turned in the day of your class.After you click the submit button, you will be taken to PayPal to make payment. Payment can be made with a credit card or a PayPal account. After you have made your payment YOU MUST click the link in PAYPAL to return to Agganis.com to receive a confirmation email.EmailThis field is for validation purposes and should be left unchanged.