Child's Name *

First Name

Last Name

Child's Date of Birth *

MM

DD

YYYY

Primary Guardian's Name *

First Name

Last Name

Phone *

(###)

###

####

Preferred Contact Method *

Call

Text

Email

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What days would you like to enroll? *

(Minimum of 2 Days)

Monday

Tuesday

Wednesday

Thursday

Please select Child's Academic Interests *

Select all that apply.

Reading

Math

Science

Physical Fitness

Creative Writing

Computer Science

Cooking

Please select Child's Art Interests *

Select all that apply.

Drawing

Acting

Dance

Music

Sculpting

Fashion

Animation

Painting