PRELIMINARY STUDENT REGISTRATION FORM

Please be sure to include current contact information so that we may confirm your student's enrollment.

Parents are required to come into the center and fill out additional information and to sign a Parental Agreement/Consent form.


Student Name *
Student Name
Parent or Guardian Name (with whom the student lives) *
Parent or Guardian Name (with whom the student lives)
Student Home Address *
Student Home Address
Student Home Phone Number *
Student Home Phone Number