Thank You – One More Step!

Our Student(s) Registration Form

Please fill in the following information, so we can prepare for our new student’s arrival!

We would like to get to know more about our kid's parent/guardian.

Parent/Guardian's Name

First Last

Date

Primary Cell

Alternate Phone (Optional)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Let us know a little bit more about the student(s) we will be working with.

Child's Name

First Last

Age

Grade

Second Child's Name

First Last

Age

Grade

Third Child's Name

First Last

Age

Grade

School(s)

Please let us know if there's anything we need to be aware of regarding our student(s).

Is there someone prohibited from picking up your child(ren)?

Does your child(ren) have a serious allergy (bees, peanuts, cats, etc.)?

How did you hear about us?

Which of our amazing Parents Referred You?

How did you heard about us (we would love to know)?

Which social media platform led you to us?

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858-204-5308

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Name(Required)

First Last

Phone

How can we help?(Required)

Please let us know what we can help you with.