Parent / Legal Gaurdian Name *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

In case we can't reach you, who may we contact in case there is an emergency?

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

#1 Child Name *

First Name

Last Name

#1 Child Birthdate *

MM

DD

YYYY

#2 Child Name

First Name

Last Name

#2 Child Birthdate

MM

DD

YYYY

#3 Child Name

First Name

Last Name

#3 Child Birthdate

MM

DD

YYYY

Which sessions are you interested in?

Tuesday, May 14th will be our first session. We will have future sessions and your feedback is appreciated.

Mon 9am-12pm

Mon 1pm - 4pm

Tues 9am - 12pm

Tues 1pm - 4pm

Wed 9am - 12pm

Wed 1pm - 4pm