Nanaberries LLC Online Registration

Registration

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Please complete the registration form below. All families are required to save a payment method at registration. Charter families: Your payment method will be saved but will NOT be charged. Please submit your PO/e-voucher request through your charter school after registration.

* denotes required fields

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Contact #1

Parent / Guardian First Name*

Last Name *

Relationship*

How Can We Contact You?

Home Phone

Cell # *

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Emergency Contact First Name*

Last Name*

How can we contact you?

Home Phone

Cell # *

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade Level*

Special Needs (if applicable)

Allergies (if applicable)

Are you using school funds?*

School Name(N/A if no charter)*

Selected Class

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade Level*

Special Needs (if applicable)

Allergies (if applicable)

Are you using school funds?*

School Name(N/A if no charter)*

Selected Class

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade Level*

Special Needs (if applicable)

Allergies (if applicable)

Are you using school funds?*

School Name(N/A if no charter)*

Selected Class

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade Level*

Special Needs (if applicable)

Allergies (if applicable)

Are you using school funds?*

School Name(N/A if no charter)*

Selected Class

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Grade Level*

Special Needs (if applicable)

Allergies (if applicable)

Are you using school funds?*

School Name(N/A if no charter)*

Selected Class

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Account Information

Payment Method*

Registration

Family Information

Where do you live?

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

Required Policies

(Show-Hide Details)