Course Offerings for People
with Special Needs

Questions, Comments, More Info?
Contact: Susan Kamm
Coordinator of Adult Education
(845) 279 at 845.279.5051, ext. 154.

BREWSTER ADULT EDUCATION
Registration Form

NAME: _________________________________ TODAY'S DATE: ______________________________
Address:____________________________________________________________________________
Telephone Number: ___________________________________________________________________
Course Name:_____________________________________ Course #:___________________________
Course Time: _____________ Course Location: __________________________ Amount Paid: _______
Emergency Contact (name and #): ________________________________________________________
Relationship: ________________________________________________________________________

To apply - print out this page and return all registration materials to:
Claudia Lima, Educational Services, PARC
1938 Route 6, Carmel, NY
(845) 225-5650 ext.149

INCLUDE: A separate check or money order for EACH CLASS payable to: BREWSTER ADULT EDUCATION.