APPLICATION


NAME                   __________________________________________

ADDRESS             __________________________________________

___________________________________________

PHONE                 ___________________________________________

BIRTH DATE        ___________________________________________


EMAIL                   ___________________________________________
PLEASE SEND THE ABOVE INFORMATION ALONG WITH YOUR DEPOSIT OR
TUITION IN FULL TO :
KENNETH & MARIE ROBERTS
49549 EAST CANAL STREET
COSHOCTON , OHIO
43812

PERSONAL CHECKS ACCEPTED  MADE OUT TO KENNETH OR MARIE
ROBERTS