REGISTRATION FORM

Thank you for registering for the After School program. We look forward to meeting you on Day 1!

Please fill out the form below and hit SUBMIT.
We will email you within 24 hours of the receipt of your request.

Be sure to download your WAIVER and have it signed by your parents and return it to us on your 1st day.


ATTENDEE INFORMATION

Student Name:

Address:

City:

State: Zip:

School:

Birthdate: Age:

Grade: GPA:

eMail:

PARENT'S CONTACT INFORMATION

Namel:

Phone Number:

eMail:


Describe your area of interests :