Use the form below to enroll your child! Please note every effort will be made to place students in one of their top two class selections.

However, the program is a first-come, first served, and as classes fill up, students may not be able to be placed in their top selections.

You can register for 1 or both Sessions which run Mon-Thur - 9am - 1pm.

*Grade Level:

  

Choose Session(s):

  

*1st Class Choice:

  

*2nd Class Choice:

  

*Firstname:

  

*Lastname:

  

*Name of School:

  

*County School District:

  

*Address

  

*City

  

*State

   Zip:

*Parent Name

  

*Parent Phone

  

*Parent Email

 

*Emergency Contact Name

  

*Emergency Contact Phone

  

*Any Daily Medication to be administered while in program?

  

*Any food Allergies?

  

*Are there any health concerns we should be aware of?

  

*What are your bus transportation preferences for drop-off/pick-up?

  

*What hobbies or sports are you involved in?

  

*Can child be photographed or videoed?

  

*How did you hear about the program?

  
*Required Field!