Registration

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Come join us in the magical land of unicorns and rainbows. We will dance in ballet & creative movement, create beautiful art, and end the day with games & activities. You can wear your best rainbow or unicorn attire to get in the spirit (optional). Magical memories will be made! Ages 3-5.

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*

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)
	Student Email:
	School:	Grade Level:
	Disabilities (Leave blank if NONE):
	Allergies (Leave blank if NONE):
	Medications (Leave blank if NONE):

Additional Information:

Other Questions/Comments:

Credit Card Verification:

Card Number:

Name as it appears on card:

Nickname:

Card Expiration Month:

Exp Year:

Address Line 1:

Address Line 2:

City:

State: Zip:

eCheck/Bank Draft:

Bank Name:

Bank Routing Number:

(9-digit number)

Your Account Name:

(Your name on your bank statement)

Your Account Type:

Account Number: