Rising Stars Registration Form

Rising Stars Student Registration Form

Please, submit 1 form per student.
Student Name *

First Name Middle Name Last Name
Student Nickname/preferred names

Nicknames
Grade this school year *
Birth Date *

Month Day Year
Gender
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Parent / Guardian Name *

First Name Last Name
Primary E-mail address for all communication:
example@example.com
Additional Parent / Guardian Name

First Name Last Name
Additional E-mail address for all communication:
example@example.com
Student or backup E-mail
example@example.com
Parent /Guardian Phone Number *

Area Code Phone Number
Student Phone Number

Area Code Phone Number
Other Contact Phone Number

Area Code Phone Number
Emergency Contact Name *
Emergency Contact Phone Number *

Area Code Phone Number
Additional Comments
We look forward to seeing you in class soon!

You will receive an e-mail confirmation once you submit this registration for each child. TUITION is due at the time of registration and on the first Thursday of every month. You can pay at the class or online at LTMT.org/rs
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Rising Stars Student Registration Form