Magic Minds, Inc. Online Registration

Student #1

Student's First Name*

Last Name*

Student's Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Current School *

Current Grade Level*

Disabilities (type N/A if none)*

Special Needs (type N/A if none)*

Allergies (type N/A if none)*

Medications (type N/A if none)*

Primary Doctor and Hospital*

Date of Most Recent Physical

Does the child have an IEP?*

If you answer Yes to having an IEP we will request a copy of the IEP to help us to provide the best care for your child.

Please choose a class based on the services you need at this time. You may choose up to 3 services. Please be sure to choose the correct location for the services your family needs. You will need to choose the services for each individual student you enter on the registration form.

Your enrollment is NOT COMPLETE until you submit the registration payment. When your registration is complete, the Parent Portal should appear so that you can make the payment immediately. The link for the Parent Portal will also be in your confirmation email.

Your enrollment will be deleted if we do not receive the registration payment within 24 hours of the registration form.

This form is not valid without the submission of mandatory Office of Child Care paperwork that can be found by clicking a link in your confirmation email. The forms can also be downloaded by clicking here:

https://drive.google.com/file/d/1l8J-aPxrNJYeeKyGCzxxfOTBtP2w-LYb/view

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student's Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Current School *

Current Grade Level*

Disabilities (type N/A if none)*

Special Needs (type N/A if none)*

Allergies (type N/A if none)*

Medications (type N/A if none)*

Primary Doctor and Hospital*

Date of Most Recent Physical

Does the child have an IEP?*

If you answer Yes to having an IEP we will request a copy of the IEP to help us to provide the best care for your child.

Please choose a class based on the services you need at this time. You may choose up to 3 services. Please be sure to choose the correct location for the services your family needs. You will need to choose the services for each individual student you enter on the registration form.

Your enrollment is NOT COMPLETE until you submit the registration payment. When your registration is complete, the Parent Portal should appear so that you can make the payment immediately. The link for the Parent Portal will also be in your confirmation email.

Your enrollment will be deleted if we do not receive the registration payment within 24 hours of the registration form.

This form is not valid without the submission of mandatory Office of Child Care paperwork that can be found by clicking a link in your confirmation email. The forms can also be downloaded by clicking here:

https://drive.google.com/file/d/1l8J-aPxrNJYeeKyGCzxxfOTBtP2w-LYb/view

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student's Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Current School *

Current Grade Level*

Disabilities (type N/A if none)*

Special Needs (type N/A if none)*

Allergies (type N/A if none)*

Medications (type N/A if none)*

Primary Doctor and Hospital*

Date of Most Recent Physical

Does the child have an IEP?*

If you answer Yes to having an IEP we will request a copy of the IEP to help us to provide the best care for your child.

Please choose a class based on the services you need at this time. You may choose up to 3 services. Please be sure to choose the correct location for the services your family needs. You will need to choose the services for each individual student you enter on the registration form.

Your enrollment is NOT COMPLETE until you submit the registration payment. When your registration is complete, the Parent Portal should appear so that you can make the payment immediately. The link for the Parent Portal will also be in your confirmation email.

Your enrollment will be deleted if we do not receive the registration payment within 24 hours of the registration form.

This form is not valid without the submission of mandatory Office of Child Care paperwork that can be found by clicking a link in your confirmation email. The forms can also be downloaded by clicking here:

https://drive.google.com/file/d/1l8J-aPxrNJYeeKyGCzxxfOTBtP2w-LYb/view

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student's Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Current School *

Current Grade Level*

Disabilities (type N/A if none)*

Special Needs (type N/A if none)*

Allergies (type N/A if none)*

Medications (type N/A if none)*

Primary Doctor and Hospital*

Date of Most Recent Physical

Does the child have an IEP?*

If you answer Yes to having an IEP we will request a copy of the IEP to help us to provide the best care for your child.

Please choose a class based on the services you need at this time. You may choose up to 3 services. Please be sure to choose the correct location for the services your family needs. You will need to choose the services for each individual student you enter on the registration form.

Your enrollment is NOT COMPLETE until you submit the registration payment. When your registration is complete, the Parent Portal should appear so that you can make the payment immediately. The link for the Parent Portal will also be in your confirmation email.

Your enrollment will be deleted if we do not receive the registration payment within 24 hours of the registration form.

This form is not valid without the submission of mandatory Office of Child Care paperwork that can be found by clicking a link in your confirmation email. The forms can also be downloaded by clicking here:

https://drive.google.com/file/d/1l8J-aPxrNJYeeKyGCzxxfOTBtP2w-LYb/view

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student's Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Current School *

Current Grade Level*

Disabilities (type N/A if none)*

Special Needs (type N/A if none)*

Allergies (type N/A if none)*

Medications (type N/A if none)*

Primary Doctor and Hospital*

Date of Most Recent Physical

Does the child have an IEP?*

If you answer Yes to having an IEP we will request a copy of the IEP to help us to provide the best care for your child.

Please choose a class based on the services you need at this time. You may choose up to 3 services. Please be sure to choose the correct location for the services your family needs. You will need to choose the services for each individual student you enter on the registration form.

Your enrollment is NOT COMPLETE until you submit the registration payment. When your registration is complete, the Parent Portal should appear so that you can make the payment immediately. The link for the Parent Portal will also be in your confirmation email.

Your enrollment will be deleted if we do not receive the registration payment within 24 hours of the registration form.

This form is not valid without the submission of mandatory Office of Child Care paperwork that can be found by clicking a link in your confirmation email. The forms can also be downloaded by clicking here:

https://drive.google.com/file/d/1l8J-aPxrNJYeeKyGCzxxfOTBtP2w-LYb/view

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

Credit Card

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

Credit Card

Required Policies

(Show-Hide Details)