Private Class Registration Form

Secondary Parent Contact Information

If you do not wish to provide this information, please press "Next" to move to next page
Name

First NameLast Name
Phone Number

Area CodePhone Number
E-mail

Your Child's Information - #2

(If only enrolling one student, please move on to next page)
Name

First NameLast Name
Birthday

MonthDayYear

Coach Selection
If you have already been matched with a coach or wish to request a specific coach, please select his or her name below (otherwise please move on to next page)

Will you be participating in school group, individual (one child/one coach), group (one coach/up to 4 children) private sessions or infant workshop?

PlayWisely Payments Enrollment
NOTE: Please refer to PlayWisely's Payment, Billing and Cancellation Policies for In-Home Classes to which, by registering and providing your payment information below, you agree to be bound.

New Student Registration- In-Home Classes$50.00

One-Time Fee Per Child

Quantity

New Student Registration- Temple Emanu-El$50.00

One-Time Fee Per Child

Quantity

New Student Registration- Prorated for Virtual Classes$25.00

One-Time Fee Per Child

Quantity

4-Week Block- Group Virtual Classes$100.00

Quantity

4-Week Block- Individual Virtual Classes$140.00

Quantity

4-Week Block- Individual In-Home Private Classes $300.00

Quantity

4-Week Block- Group (2 child) In-Home Private Classes$180.00

Quantity

4-Week Block- Group (3 child) In-Home Private Classes$160.00

Quantity

4-Week Block- Group (4 child) In-Home Private Classes 2$140.00

Quantity

Total $0.00

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