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New Student Registration
Student's First Name
Student's Last Name
Student's Birthday
Student's Gender
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Street Address
Street Address Line 2
City
Region/State/Province
Postal / Zip code
Country
Country
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Healthcare Number
Doctor's Name
Doctor's Phone Number
Parent or Guardian's First and Last Name
Parent or Guardian's Cell Number
Parent or Guardian's Email Address
Parent or Guardian's Address (same as Student's?)
Yes
No
Street Address
Street Address Line 2
City
Region/State/Province
Postal / Zip code
Country
Country
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Add another parent?
Yes
No
Parent or Guardian (2) First and Last Name
Parent or Guardian (2) Cell
Parent or Guardian (2) Email Address
Parent or Guardian (2) Address (same as Student's?)
Yes
No
Street Address
Street Address Line 2
City
Region/State/Province
Postal / Zip code
Country
Country
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Is your child immunized?
Yes
No
Does your child have any allergies, medical conditions, or require any medications?
Emergency Contact First and Last Name
Emergency Contact Phone Number
Emergency Contact Street Address
Street Address Line 2
City
Region/State/Province
Postal / Zip code
Country
Country
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Emergency Contact's Relationship to student
Do you agree to a photo release?
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No
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Choose a Program and Pay Structure
After School Program - WEEKLY RATE - $185
After School Program - DAILY RATE - $45
Summer Program - FLAT RATE - $150
Complete Registration
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