Children Program Registration Form 2026-2027

Children Program Registration Form 2026-2027
PARENTS/GUARDIANS INFORMATION
- Mother's Full Name
  
  Mother's First NameMother's Maiden NameMother's Last Name
- Mother's Phone Number
  Format: (000) 000-0000.
- Mother's Email
  example@example.com
- Mother's Home Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Father's Name
  
  Father's First NameFather's Last Name
- Father's Phone Number
  Format: (000) 000-0000.
- Father's Email
  example@example.com
- Father's Address (if different from above)
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Who do you wish to be the primary contact to receive our school emails and messages?
  
  Other
- Emergency Contact
  
  Emergency contact's First NameEmergency contact's Last Name
- Emergency Contact Relationship to Student
- Phone Number Of Person To Contact In Case Of Emergency
  Please enter a valid phone number.Format: (000) 000-0000.
- Email Of Person To Contact In Case Of Emergency
  example@example.com

STUDENTS INFORMATION
How many Students would you like to register?

Please verify that you are human
Select a Payment Method

Please select one or both options below and proceed with your payment

1 Child Registration

for 1 child only

$300.00 Quantity
Item subtotal:

Total

Credit Card

(Once submitted, you will be redirected to fill the Liability Release Forms for 2026-2027, valid for Children Program Participants & MYO)

Name of Payee

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
The amount due is $
(Once submitted, you will be redirected to fill the Liability Release Forms for 2026-2027, valid for Children Program Participants & MYO)

You can send the payment to the following number:

+1 (310) 614-8188

Kindly leave a note with the name(s)of your registered child(ren).
Please provide the name associated with your Zelle account.
The amount due is $
(Once submitted, you will be redirected to fill the Liability Release Forms for 2026-2027, valid for Children Program Participants & MYO)
Should be Empty: