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First Child    

Child's First Name*:

 
Child's Last Name*:
 
Date of Birth *:
  / /
     
Second Child (If applicable. Applies only to enrollment forms)

Child's First Name*:

 
Child's Last Name*:
 
Date of Birth *:
 
/ /
 
 
Parent Information
Parent's First Name*:
 
Parent's Last Name*:
Emergency Number*:
 
Home Phone*:
 
Parent's Email*:
 
Street Address*:
 
City*:
 
State*:
 
  Zip Code*:
Please Select a Class*  
First time registering with us? * YES       NO
  Registration fee of $25 for first-time families only.