Wild Wonderment Online Registration

Registration

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Please complete the following registration form. Important: When selecting classes there are 2 options. You can pay for the entire year upfront and receive a $100 discount or you can pay by session. If you would like to pay upfront please select the "Full Year" class. If you would like to pay by session, please select each of the 6 classes. Once you select the first class, it will take you back to the main screen and you will want to click "add class" again until all classes are added.

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact (Name, Phone #, Relationship to Child)*

Contact #1

Primary Contact (Parent/Legal Guardian) First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone

Work #

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

On-Site Caregiver if different from Parent/Legal Guardian. First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

What grade would the child be in when program starts?*

Will someone other than the parent be bringing child? If so, please complete Caregiver Information.*

Will additional siblings be staying who are not in the program? (please include ages)*

Does you child have any special needs you would like us to be aware of?

Does your child have any food, drug or environment allergies? Please specify if anaphylactic..

Medications

Primary Doctor

Do you understand that this is a Christian program and parents must stay on-site/assist?*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

What grade would the child be in when program starts?*

Will someone other than the parent be bringing child? If so, please complete Caregiver Information.*

Will additional siblings be staying who are not in the program? (please include ages)*

Does you child have any special needs you would like us to be aware of?

Does your child have any food, drug or environment allergies? Please specify if anaphylactic..

Medications

Primary Doctor

Do you understand that this is a Christian program and parents must stay on-site/assist?*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

What grade would the child be in when program starts?*

Will someone other than the parent be bringing child? If so, please complete Caregiver Information.*

Will additional siblings be staying who are not in the program? (please include ages)*

Does you child have any special needs you would like us to be aware of?

Does your child have any food, drug or environment allergies? Please specify if anaphylactic..

Medications

Primary Doctor

Do you understand that this is a Christian program and parents must stay on-site/assist?*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

What grade would the child be in when program starts?*

Will someone other than the parent be bringing child? If so, please complete Caregiver Information.*

Will additional siblings be staying who are not in the program? (please include ages)*

Does you child have any special needs you would like us to be aware of?

Does your child have any food, drug or environment allergies? Please specify if anaphylactic..

Medications

Primary Doctor

Do you understand that this is a Christian program and parents must stay on-site/assist?*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

T-Shirt Size*

What grade would the child be in when program starts?*

Will someone other than the parent be bringing child? If so, please complete Caregiver Information.*

Will additional siblings be staying who are not in the program? (please include ages)*

Does you child have any special needs you would like us to be aware of?

Does your child have any food, drug or environment allergies? Please specify if anaphylactic..

Medications

Primary Doctor

Do you understand that this is a Christian program and parents must stay on-site/assist?*

Please click on the Search button below, then choose the class.

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

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

Required Policies

(Show-Hide Details)