FALL 2024 Class Registration Form

FALL 2024 Class Registration Form
Student's Name*

First NameLast Name
Student Phone Number
Please enter a valid phone number.
Student Date of Birth*

MonthDayYear
Date
Students Numerical Age at time of September 1st, 2024*
Gender*
Parent's Name*

First NameLast Name
Parent's Phone Number*
Please enter a valid phone number.
Second Parent's Name

First NameLast Name
Second Parent's Phone Number
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email (Parent)*
example@example.com
Second Email (Parent)
example@example.com
Email (Student)
example@example.com
Emergency Contact (not listed above)*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.