Home
About Us
Classes
Contact Us
Calendar
Student First Name:
*
Parent/Guardian Name:
*
Student Last Name:
*
Cell Phone
*
Home Phone
Family Address
*
Emergency Contact's Relation to Student:
*
Grandparent
Aunt/Uncle
Friend of Family
Other
Parent/Guardian Phone:
Any medical conditions or concerns that the staff needs to be made aware of:
In regards to account charges:
*
I authorize my student to receive bottled water and understand that the charge ($1.00) will be placed on my account
I do not authorize my student to receive bottled water
Thank you for registering! You will hear back within 48-72 hours.
Family Email:
*
Check here to receive email updates
Student's School:
Parent/Guardian Name:
Parent/Guardian Phone:
*
Emergency Contact Name:
*
Student's Grade
Pre-K
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Student Birthdate
*
In regards to account charges:
*
I authorize my student to receive money for the vending machine and understand that the charge ($1.00) will be placed on my account
I do not authorize my student to receive money for the vending machine
Student Cell Phone (if applicable)
Emergency Contact Phone:
*
Family/Guardian Last Name:
*
Registration Form
View on Mobile