Registration

Child's Name *

First Name

Last Name

Child's Gender

Male

Female

Child's Date of Birth *

MM

DD

YYYY

I would like to enroll more than one child

Yes

No

How many times a week?

One time a week

Twice a week?

Which class do you like to attend?

Class 1?

Class 2?

How long do you want to attend? (Summer)

For 1 month

For 3 months

More than 6 months

Parent's Name *

First Name

Last Name

Parent's Phone Number *

(###)

###

####

Additional Parent's Name

First Name

Last Name

Additional Parent's Phone Number

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country