Registration Form Child Information * First Name Last Name .Date of Birth * MM DD YYYY .Does your child have any known medical conditions, allergies, or special needs we should be aware of to ensure their safety and well-being? Yes No ..If answer yes, please explain .Parents/Gaurdian Information * First Name Last Name .Phone * (###) ### #### .Email * .Address Address 1 Address 2 City State/Province Zip/Postal Code Country . Emergency Contact Info * First Name Last Name .Phone * (###) ### #### .Select Class * Mondays 3:30pm - 6:00pm Kindergarten - Grade 2 Thursday 3:30pm - 6:00pm Grade 3- Grade 6 Thank you for your registration! We will contact you to confirm registration.
