Please fill out the information below in its entirety.
Child's First Name
*
Child's Last Name
*
Gender
*
Male
Female
Date of Birth
*
Street Address
*
City
*
Postal Code
*
Mobile Number
Phone Number
Parent's Names
*
Primary Email
*
Secondary Email
Class Preference
*
2 days per week (Tues/Thurs)
3 days per week (Mon/Wed/Fri)
Does your child have any special needs?
*
Yes
No
if YES please specify:
Does your child have severe food allergies?
*
Yes
No
if YES please specify:
Additional Information or Class Request
OFFICE USE ONLY:
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