Student Name
*
Gender
*
M
F
Other
School
*
Grade & School in Fall
*
Age
*
Birth Date
*
-
Month
-
Day
Year
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Mother’s Name
*
Email
*
Phone
*
Father’s Name
*
Email
*
Phone
*
Address
*
Emergency contact’s phone
*
Emergency contact
*
Relationship
*
Registering with a sibling/friend?
Yes
No
Name of sib/friend
What is your child’s plan to be picked up (and by whom) or walk home after class?
*
Characterize your child
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Dietary Restrictions
Medical Conditions & Allergies
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I agree to the terms and conditions
Click here to view Terms and Conditions
Choose Classes
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Tuesday: 5pm-6pm
$80.00
$
80.00
Ages : 5-7
Tuesday: 6.05pm-7.05pm
$80.00
$
80.00
Ages : 7-10
Wednesday : 4.30pm-5.30pm
$80.00
$
80.00
Ages : 5-7
Wednesday : 5.35pm-6.35pm
$80.00
$
80.00
Ages : 7-10
Wednesday : 6.40pm-7.40pm
$80.00
$
80.00
Ages : 10+
Thursday : 5pm-6pm
$80.00
$
80.00
Ages : 7-10
Thursday : 6.05pm-7.05pm
$80.00
$
80.00
Ages : 10+
Friday: 5pm-6pm
$80.00
$
80.00
Ages : 7-10
Friday: 6.05pm-7.05pm
$80.00
$
80.00
Ages : 10+
Friday: 7.10pm-8.10pm
$80.00
$
80.00
Ages : 10+
Subtotal
$0.00
$
0.00
Tax
$0.00
$
0.00
Shipping
$0.00
$
0.00
Total
$0.00
$
0.00
Submit Form & make the payment
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