2025-26 School Year Programs Registration

Student Information

(This form is for one student only. If you wish to register another child, please complete this form again for the second student.)

Student's First Name*

Student's Last Name*

Birth Date*

Date

Age

As of Date of First Class

Gender*

FemaleMale

Schooling Type*

Public SchoolPrivate SchoolHomeschool

Name of School

Grade*

During the 2024-25 School Year

Parent/Guardian Information

Parent's First Name*

Parent's Last Name*

Parent's E-mail*

example@example.com

Parent's Telephone Number*

Text Communication

Please check here if we may communicate with you via text to the number above.Check here if we may communicate with you via text to a different number

Emergency Information

Please enter emergency contact, if different than parent/guardian listed above. (Name, phone number)

Does the student have any allergies, dietary restrictions, chronic illness, or medical conditions of which we should be aware? If yes, please describe.

Terms and Conditions

Payment Information

Offered Programs: