Registration
2021-2022
Childs Name
First Name
Last Name
Child's Date of Birth
mm/dd/yyyy
Grade
Please Select
3 year old
4 year old
Kindergarten
1st grade
2nd grade
3rd grade
4th grade
5th grade
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please list any allergies / medical conditions
Parent / Guardian Name
First Name
Last Name
Cell Phone
Please enter a valid phone number.
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Is Bus Transportation Needed? (bus transportation will be limited)
yes
no
Submit
Should be Empty: