Enrichment Class Registration
Please fill out the form below
Student's First Name
*
Student's Last Name
*
Teacher's Last Name
*
Student's Grade
*
Please Select
Kindergarten
Grade 1
Grade 2
Grade 3
Parent / Guardian Full Name
*
Phone #: Home
*
Phone #: Work
Phone #: Cell
Parent's / Guardian's Email
*
Emergency Contact Full Name
*
Must be different from Parent/Guardian
Emergency Contact: Phone Number
*
(Must be different from Parent/Guardian
Submit
Should be Empty: