Please make sure to sign in to your Parental Portal to Select your Class(es) after filling out the Registration Form.
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
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
Any medical conditions we should be aware of?*
Who will be picking your student up? List any possibilities. *
Please make sure to log in to your Parent Portal, after Registering, to pick which Summer Class(es) you want.
Additional Information:
Other Questions/Comments:
Credit Card Verification:
Card Number:  
Name as it appears on card:
Card Expiration Month:   Exp Year:
Address Line 1: Address Line 2:
City: State: Zip: