BIRDIE BASICS REGISTRATION FORM
Student Name
*
First Name
Last Name
Student Age
*
2nd Students Name
First Name
Last Name
2nd Students Age
3rd Students Name
First Name
Last Name
3rd Students Age
Select a Semester
*
Summer Semester (May 13th - July 14th)
Summer Semester 2 (July 15th - September 8th)
Fall Semester (September 9th - December 15th)
Select a Class Time
*
Saturday's at 1PM (Ages 3-4)
Wait List Friday's at 6PM (Ages 3-6)
Wait List Saturday's at 2PM (Ages 5-6)
Student's Guardian
*
First Name
Last Name
Student Guardian's Email
*
example@example.com
Student Guardian's Phone Number
*
Please enter a valid phone number.
Add Another Email to Our Master Emailing List
example@example.com
How Did You Hear About Our Program?
*
ACADEMY PACKAGES
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Birdie Basics Monthly Package
(4) 1 Hour Future 36ers Classes Per Month
$
160.00
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