Choice Education Network, Inc Online Registration

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor*

Other:

Enter your family's contact information, names and birth dates of the students you wish to enroll, and select "enroll in classes." Filters can be applied to sort classes by age group, days offered and "Location" (which is our PROGRAM TYPE NOT a physical location change). If you're having difficulties enrolling online, please contact Amy Chiodo for assistance at AmyChiodo@ChoiceEd.org or TEXT -479935-0757 or EMILY FREE at EmilyFree@ChoiceEd.org. All classes are located at Elmdale Baptist Church in Springdale AR

CLASSES ENROLL AT FULL PRICE. Teacher rates, co-op rates, or other negotiated rates are MANUALLY adjusted after enrollment. Pay only your registration fee per student at time of enrollment.

Classes are a le carte and monthly installments are permitted.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor*

Other:

Enter your family's contact information, names and birth dates of the students you wish to enroll, and select "enroll in classes." Filters can be applied to sort classes by age group, days offered and "Location" (which is our PROGRAM TYPE NOT a physical location change). If you're having difficulties enrolling online, please contact Amy Chiodo for assistance at AmyChiodo@ChoiceEd.org or TEXT -479935-0757 or EMILY FREE at EmilyFree@ChoiceEd.org. All classes are located at Elmdale Baptist Church in Springdale AR

CLASSES ENROLL AT FULL PRICE. Teacher rates, co-op rates, or other negotiated rates are MANUALLY adjusted after enrollment. Pay only your registration fee per student at time of enrollment.

Classes are a le carte and monthly installments are permitted.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor*

Other:

Enter your family's contact information, names and birth dates of the students you wish to enroll, and select "enroll in classes." Filters can be applied to sort classes by age group, days offered and "Location" (which is our PROGRAM TYPE NOT a physical location change). If you're having difficulties enrolling online, please contact Amy Chiodo for assistance at AmyChiodo@ChoiceEd.org or TEXT -479935-0757 or EMILY FREE at EmilyFree@ChoiceEd.org. All classes are located at Elmdale Baptist Church in Springdale AR

CLASSES ENROLL AT FULL PRICE. Teacher rates, co-op rates, or other negotiated rates are MANUALLY adjusted after enrollment. Pay only your registration fee per student at time of enrollment.

Classes are a le carte and monthly installments are permitted.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor*

Other:

Enter your family's contact information, names and birth dates of the students you wish to enroll, and select "enroll in classes." Filters can be applied to sort classes by age group, days offered and "Location" (which is our PROGRAM TYPE NOT a physical location change). If you're having difficulties enrolling online, please contact Amy Chiodo for assistance at AmyChiodo@ChoiceEd.org or TEXT -479935-0757 or EMILY FREE at EmilyFree@ChoiceEd.org. All classes are located at Elmdale Baptist Church in Springdale AR

CLASSES ENROLL AT FULL PRICE. Teacher rates, co-op rates, or other negotiated rates are MANUALLY adjusted after enrollment. Pay only your registration fee per student at time of enrollment.

Classes are a le carte and monthly installments are permitted.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor*

Other:

Enter your family's contact information, names and birth dates of the students you wish to enroll, and select "enroll in classes." Filters can be applied to sort classes by age group, days offered and "Location" (which is our PROGRAM TYPE NOT a physical location change). If you're having difficulties enrolling online, please contact Amy Chiodo for assistance at AmyChiodo@ChoiceEd.org or TEXT -479935-0757 or EMILY FREE at EmilyFree@ChoiceEd.org. All classes are located at Elmdale Baptist Church in Springdale AR

CLASSES ENROLL AT FULL PRICE. Teacher rates, co-op rates, or other negotiated rates are MANUALLY adjusted after enrollment. Pay only your registration fee per student at time of enrollment.

Classes are a le carte and monthly installments are permitted.

Enroll in Classes

Select Class

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies

(Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Credit Card

eCheck/Bank Draft

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Credit Card

eCheck/Bank Draft

Required Policies

(Show-Hide Details)