Registration

Event:

Start Date/Time:

End Date/Time:

Fee per Student:

Room:

* - denotes required fields

Family Information

	First Name:*	Last Name: *
	Type*
	Home Phone:	Cell #: Work #:
	Email:*	(Emails are kept confidential)

	Address: *
	City: *	State: * Zip: *
	Emergency Contact Info (Not Contact #1 or #2)

Students entered below will be added to your family's account

Add New Student #1:

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	Student's First Name: *	Last Name: *
	Student Gender:	Birth Date: * (format=mm/dd/yyyy)
	School:	Grade Level:*
	Disabilities (Leave blank if NONE):
	Select Color and Size Below :
	Preschool Lavender - Size:
	Preschool Black-Size:
	Leveled Class Purple-Size:
	Leveled Class Black-Size:

Additional Information:

Payment

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I've read the above and agree.

Assumption of Risk

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I've read the above and agree.

Release of Liability

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I've read the above and agree.

Enter your Full Name: