Onsite School Program Registration Child informationName* First Last Birthdate* MM slash DD slash YYYY Gender*FemaleMaleSpecial NeedsClassroom (If Known)Parent InformationName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Email* Used to send you a receipt and important updatesEmergency ContactFill out this section if emergency contact is different from above.Name* First Last Phone*Relationship to child*How did you hear about us?* Child’s School Post Card in Mail Curb-Side Sign Facebook Twitter Google Website Friend Waiver* I have read and agree to the Waiver and Release. School Program FeesSelect Session Attending* Fall Session Spring Session Monthly Auto Pay This field is hidden when viewing the formSelect Session Attending Fall Session Spring Session Monthly Auto Pay Fall Session Price: Spring Session Price: Registration Fee* Price: Monthly Auto Pay* Price: Total $0.00 Please Note: Payments are Non-Refundable!Payment MethodPayPal CheckoutCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name
