Pre-Registration Form2024 Summer Program Parent/Guardian Full Name * First Name Last Name Parent/Guardian Email Address * Phone Number * (###) ### #### Relationship to Child * Father Mother Legal Guardian Other Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Child Full Name * First Name Last Name Child Date of Birth * MM DD YYYY Child Age * Child Gender * Male Female Entering School Grade * Please Select One Pre-K Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th Special Needs or Accommodations (if applicable) leave blank or enter N/A if not applicable Additional Information Please provide any additional information you'd like us to know about your child, their interests, or their goals in attending our programs. Emergency Contact Full Name * Please provide at least one emergency contact other than the parent/guardian listed above. First Name Last Name Relationship to Child * Father Mother Legal Guardian Other Emergency Contact Phone Number * (###) ### #### Once you click Send, you will be redirected to pay your $50 app fee. Thanks! Thank you!
