My student is signed up for: *
Child's Name *
Child's Name
Emergency Contact Information
Primary Class-Time Contact *
Primary Class-Time Contact
Phone Number *
Phone Number
Secondary Class-Time Contact *
Secondary Class-Time Contact
Phone Number *
Phone Number
Please share any notes about others who have permission to pick up your child, or if there is anyone who should never pick up your child.
Medical Information
Physician's Phone Number
Physician's Phone Number
Additional Information
Permission Waivers
By typing my name below, I am confirming that all the information above is correct.