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7
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1
Parent/Guardian Name
*
This field is required.
Please enter parent/guardian's first and last name.
First Name
Last Name
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2
Parent/Guardian Phone Number
*
This field is required.
Please enter parent/guardian's phone number.
Please enter a valid phone number.
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3
Parent/Guardian Email
*
This field is required.
Please enter parent/guardian's email.
example@example.com
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4
Child's Name
*
This field is required.
Please enter child's first and last name.
First Name
Last Name
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5
Child's Birthdate
*
This field is required.
Please enter child's birthdate.
/
Date
Month
Day
Year
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6
Child's Photo
Please upload a clear photo of your child's face - not required but very helpful.
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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7
Please pick a screening date and time that will work for you. Plan to arrive 15 before your child's scheduled time for registration.
*
This field is required.
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