Registration

Please use the form below to register your child for class. Payment for the session is due at time of registration to reserve your spot. If paying up front is an issue please talk with me about setting up a payment plan. Your payment options are Venmo, Cash, or Check.

Select Class:

Preferred Day/Time:	(e.g. Tuesdays 09:30)
Preferred Location:

Parent's First Name:
Parent's Last Name:
Address Line 1:
Address Line 2:
City:
State/Province:
Zip/Postal Code:
Email Address:
Home Phone Number:	- -
Work Phone Number:	- -
Cell Phone Number:	- -

Alt. Contact Person:
Alt. Contact Phone:	- -

Child's First Name:
Child's Last Name:
Child's Current Age:	months years
Child's Birthdate:	(MM/DD/YYYY)

List any allergies or medical issues of which the teacher should be aware:


How did you hear about us?:

Other:

Question/Comment: