Enrollment Application

Enrollment Form

Please provide the required information below to register your child.

Child's Information
Child's Name*
First Last
Child's Age*
Sex*
- Male
- Female
Parent/Guardian's Information
Parent/Guardian's Name*
First Last
Address
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Person to contact in case of an emergency
Emergency Contact Name*
First Last
Emergency Contact Address
Street Address Address Line 2 City State ZIP Code
Health Information
Name of child's doctor*
Phone
Hospital Preference
Please list down any allergies or dietary restrictions for your child
Additional Information
Enrollment Fee
Choose a Session*
We have two sessions available on Mondays, Wednesdays & Fridays. The prices below are monthly.
Total
$0.00