Class Registration Form

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Child's Name *

First

Last

Child's Age *

Child's Grade for 2024-2025 School Year *

Date of Birth *

School Attended *

Allergies

Anything else we may need to know about your child

Parent/Guardian's Name *

First

Last

Parent/Guardian's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian's Phone *

Parent/Guardian's Email *

Authorized to pickup your child (other than parent)

Emergency Contact Name *

First

Last

Emergency Contact Phone *

Relationship to Child *

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