Enrollment Application

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Enrollment Application

Please fill out the information below to enroll your child in our after school program. You will recieve an email confirmation and payment options. We are very excited to have your child as part of our unique after school program. Please insure you sign up for news letters and check our calendar weekly for all the upcoming events.

* Required fields
Name *
E-mail Address *
Child's Name *
Address *
Mother's work address *
Mother's work phone *
Father's work address *
Fathers's work phone *
Father's Cell Phone
Mother's cell phone *
Name of emergency contact *
Address of Emergency contact *
Phone number of emergency contact *
Name of 2nd emergency contact
Address of 2nd emergency contact *
Phone number of emergency contact *

I have read and agree to the Privacy Policy *

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