First Child Name:
Date of Birth:
Gender:
Parent/Guardian Name:
Home Address:
City/State/Zip:
Phone Number:
Email Address:
Does your child have any allergies or medical conditions? If yes, please explain:
Do you want to include other child in your family?
Please select:
Session | Program | Fees per week | Select | No. of Children | Fees | |
|---|---|---|---|---|---|---|
Session 1 | Program A | $0.00 | ||||
Session 2 | Program B | $0.00 | ||||
Session 3 | Program C | $0.00 | ||||
Session 4 | Program D | $0.00 | ||||
Session 5 | Program E | $0.00 | ||||
Session 6 | Program F | $0.00 | ||||
Session 7 | Program G | $0.00 | ||||
Session 8 | Program H | $0.00 | ||||
Session 9 | Program I | $0.00 | ||||
Total Fees | $0.00 |
I give permission for my child/children to join the activities.
Parent/Guardian Signature:
| Total Fees | $0.00 |
| Total | $0.00 |