To register, please complete the form below.

Fees are fully refundable less a $25 credit card processing and cancellation fee prior to the start of the online class. Once you click "Start Course", there will be no refund to the classroom portion of the fee. Call 651-351-9150 if you want to transfer to another class.

Session:

Online Class - Self-Paced
Online Classroom only

Start Date:

Flexible

End Date:

6 Months after registration

Times:

Flexible. Not more than 3 hours/day.

Days of the Week:

Flexible

Package Cost:

$100.00

Paid in Full Amount:

$100.00

1^st Classroom Payment:

$100.00

Student Information

* Indicates Required Field

Student First Name: *

(As it appears on student's birth certificate)

Student Middle Name: *

(As it appears on student's birth certificate. If no middle name, please type leave this field blank)

Student Last Name: *

(As it appears on student's birth certificate)

Nickname:

(optional)

Suffix:

(optional, Example "Jr." or "III" as it appears on birth certificate)

Primary Address Information

Address 1 *

Address 2

City *

State *

Zip *

Secondary Address Information

Address 1

Address 2

City

State

Zip

Home Phone:

(optional)

Student Cell Phone:

(recommended)

Student Email:

(recommended)

Birthdate: *

(mm/dd/yyyy)
Safeway's program is for teens under age 18

Gender:

(optional)

Parent/Guardian Information

Parent/Guardian (required)

First Name: *

Last Name: *

Email: *

Phone: *

Additional Parent/Guardian (optional)

First Name:

Last Name:

Email:

Phone:

Note to Instructor (optional):
(Please note any special circumstances
concerning the student)

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