Student – New Day Care Service Registration Please enable JavaScript in your browser to complete this form.Parent or Guardian Name *FirstLastEmail *Phone *AddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeChild's DetailsName of child to enroll *FirstLastAllergies *Child's gender *MaleFemaleChild's age *2.5 - 6 years old - attending day care5-12 years old - attending primary schoolYour relationship to the child *Parent or legal guardianOtherPlease specify your relationship to the child if other.Day Care Center InformationWhat is your day care contact name? *Day care contact number? *What is the name of your day care center? *Attendance RequirementsAre you registering more than one child *YesNoWhich class type are you interested in? *Dance (Ballet, Jazz, Tap, Hip Hop, African Technique)Technology (Robotics & Engineering)Is this for in school services (between 8am and 3pm) or after school services?In school service requestAfter school service requestBothHow many days would you like serviced? *One day, one dance class combo per child/monthly costOne day, one class, tech comboMultiple days, multiple class typesOur maximum class size is 12 students. We are able to service multiple days and multiple times. Classes run between 55 and 60 minutes in length. For multiple kids, days, and classes, we will contact you to discuss pricing and discounts.Total weekly cost *$ 0.00Square *CardName on CardEmergency ContactPlease provide an alternative contact person in case of emergency. Emergency contacts must be over the age of 18 and capable of caring for the child if you are unavailable.Emergency Contact's Name *FirstLastEmergency Contact's Phone NumberEmergency Contact's relationship to the child *Parent or legal guardianParent or legal guardianGrandparentSibling (over 18 years old)Extended familyOtherPlease provide any additional contact detailsAdditional CommentsName *FirstLastSubmit The power ofimaginationfascinationattentionpassioncuriositymakes us infinite
Student – New Day Care Service Registration
