Student Registration Form

Emergency Contact 1*

First NameLast Name
Relationship to Child*
ex. Father, Mother, etc.
Phone Number Of Person To Contact In Case Of Emergency*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Of Person To Contact In Case Of Emergency
example@example.com
Emergency Contact 2

First NameLast Name
Relationship to Child
ex. Father, Mother, etc.
Phone Number Of Person To Contact In Case Of Emergency
Please enter a valid phone number.
Contact Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Of Person To Contact In Case Of Emergency
example@example.com

Child 1*

First NameLast Name
Birthday*

MonthDayYear
Date
Shirt Size (Children Size)
Does this child have any allergies? If so, please list/explain below*
List or explain allergies of child #1
Child 2

First NameLast Name
Birthday

MonthDayYear
Date
Shirt Size (Children Size)
Does this child have any allergies? If so, please list/explain below
List or explain allergies of child #2
Child 3

First NameLast Name
Birthday

MonthDayYear
Date
Shirt Size (Children Size)
Does this child have any allergies? If so, please list/explain below
List or explain allergies of child #3

PAYMENT*

Registration

This fee ensure your desire to make use of OTC services.

$30.00

Total

$0.00