M-Squared of Magic Minds Online Registration

Registration

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Welcome to Magic Minds! We are excited to help your child grow. Please complete the form below. For security, your payment info is encrypted and hidden—our staff cannot see your private details. We will never charge your card without your permission. Need help? Text us at 443-927-8777 if you have any questions during registration. Thank you for choosing a program dedicated to your child's success! Take Care, The Magic Minds Team

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name

Family Information

Oldest Child's Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Primary Phone*

Additional Info

Emergency Contact Name, Address and Phone Number (outside of Parents/Guardians)*

Authorized Pick Up Person #1 *

Authorized Pick Up Person #2*

Contact #1

Parent/Guardian #1 First Name*

Last Name *

Relationship to Student(s)*

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

Parent/Guardian #2 First Name

Last Name

Relationship to Student(s)

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's Gender*

Birth Date*

Cell #

Additional Info

Student Email

T-Shirt Size*

Current School*

Current (Or Recently Completed) Grade Level*

Disabilities (Type NONE if necessary)*

Special Needs (Type NONE if necessary)*

Allergies (Type NONE if necessary)*

Medications (Type NONE if necessary)*

Primary Doctor and Hospital*

Date of Most Recent Physical

Does the child have an IEP?*

Does the child have a 504 ?*

How to Choose Your Classes

1. Pick Your Services: Please click on the "Select Class" button below, then choose your class. You may pick up to 3 services (like Summer Camp or After School). Make sure to choose the correct location for each child you are signing up.

2. IEP Information: If your child has an IEP, please select "Yes." We will request a copy so our certified teachers can provide the best instruction and care for your student.

3. Finish Your Enrollment: Your spot is NOT reserved until the registration fee is paid. Once you submit this form, please log in to the Parent Portal immediately to pay.

Note: If payment is not received within 24 hours, your registration will be deleted.

4. Required Paperwork: You must submit mandatory Office of Child Care forms to attend. If the link below is not clickable, please copy and paste it into your browser:

Link: 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 (Or Recently Completed) Grade Level*

Disabilities (Type NONE if necessary)*

Special Needs (Type NONE if necessary)*

Allergies (Type NONE if necessary)*

Medications (Type NONE if necessary)*

Primary Doctor and Hospital*

Date of Most Recent Physical

Does the child have an IEP?*

Does the child have a 504 ?*

How to Choose Your Classes

2. IEP Information: If your child has an IEP, please select "Yes." We will request a copy so our certified teachers can provide the best instruction and care for your student.

3. Finish Your Enrollment: Your spot is NOT reserved until the registration fee is paid. Once you submit this form, please log in to the Parent Portal immediately to pay.

Note: If payment is not received within 24 hours, your registration will be deleted.

4. Required Paperwork: You must submit mandatory Office of Child Care forms to attend. If the link below is not clickable, please copy and paste it into your browser:

Link: 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 (Or Recently Completed) Grade Level*

Disabilities (Type NONE if necessary)*

Special Needs (Type NONE if necessary)*

Allergies (Type NONE if necessary)*

Medications (Type NONE if necessary)*

Primary Doctor and Hospital*

Date of Most Recent Physical

Does the child have an IEP?*

Does the child have a 504 ?*

How to Choose Your Classes

2. IEP Information: If your child has an IEP, please select "Yes." We will request a copy so our certified teachers can provide the best instruction and care for your student.

3. Finish Your Enrollment: Your spot is NOT reserved until the registration fee is paid. Once you submit this form, please log in to the Parent Portal immediately to pay.

Note: If payment is not received within 24 hours, your registration will be deleted.

4. Required Paperwork: You must submit mandatory Office of Child Care forms to attend. If the link below is not clickable, please copy and paste it into your browser:

Link: 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 (Or Recently Completed) Grade Level*

Disabilities (Type NONE if necessary)*

Special Needs (Type NONE if necessary)*

Allergies (Type NONE if necessary)*

Medications (Type NONE if necessary)*

Primary Doctor and Hospital*

Date of Most Recent Physical

Does the child have an IEP?*

Does the child have a 504 ?*

How to Choose Your Classes

2. IEP Information: If your child has an IEP, please select "Yes." We will request a copy so our certified teachers can provide the best instruction and care for your student.

3. Finish Your Enrollment: Your spot is NOT reserved until the registration fee is paid. Once you submit this form, please log in to the Parent Portal immediately to pay.

Note: If payment is not received within 24 hours, your registration will be deleted.

4. Required Paperwork: You must submit mandatory Office of Child Care forms to attend. If the link below is not clickable, please copy and paste it into your browser:

Link: 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 (Or Recently Completed) Grade Level*

Disabilities (Type NONE if necessary)*

Special Needs (Type NONE if necessary)*

Allergies (Type NONE if necessary)*

Medications (Type NONE if necessary)*

Primary Doctor and Hospital*

Date of Most Recent Physical

Does the child have an IEP?*

Does the child have a 504 ?*

How to Choose Your Classes

2. IEP Information: If your child has an IEP, please select "Yes." We will request a copy so our certified teachers can provide the best instruction and care for your student.

3. Finish Your Enrollment: Your spot is NOT reserved until the registration fee is paid. Once you submit this form, please log in to the Parent Portal immediately to pay.

Note: If payment is not received within 24 hours, your registration will be deleted.

4. Required Paperwork: You must submit mandatory Office of Child Care forms to attend. If the link below is not clickable, please copy and paste it into your browser:

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

Enroll in Classes

Select Class *

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number *

Exp Month *

Exp Year *

Card Nickname

Name as it appears on card *

Address Line 1

Address Line 2

City

State

Zip*

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)