Student Registration Form

Student Registration Form
Parent Name*

First NameLast Name
Parent Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Phone Number 2
E-mail*
example@example.com
Additional E-mail
example@example.com
Child Name*

First NameLast Name
Date of Birth

MonthDayYear
Date
Days Attending (2 days minimum)*

TuesdayWednesdayThursday
Allergies
Child Name (2)

First NameLast Name
Date of Birth

MonthDayYear
Date
Days Attending (2 days minimum)

TuesdayWednesdayThursday
Allergies
Child Name (3)

First NameLast Name
Date of Birth

MonthDayYear
Date
Days Attending (2 days minimum)

TuesdayWednesdayThursday
Allergies
Are you able to help volunteer one or two mornings per month? Note: Volunteering is not required.

YesNo
To complete registration, please use the link below to pay the $125 deposit and submit this form. This amount is per family, not per child.

Deposit Pay Link
Additional Comments/Concerns:
Should be Empty: