Registration

Movie Night - Session 1 Playing Moana

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 other than Contact 1 or 2*

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

Add New Student #1:

(Show-Hide Details)

	Student's First Name: *	Last Name: *
	Birth Date: *	(format=mm/dd/yyyy)
	Student Email:
	School:*	Grade Level:*
	Allergies (Leave blank if NONE):
	Medications (Leave blank if NONE):

Additional Information: