Student #1 Name *

First Name

Last Name

Student #1 DOB *

MM

DD

YYYY

Are you interested in our core hybrid days: Tuesday & Thursday? *

Yes

No

Which enrichment days are you interested in? *

Select all that apply

Monday

Wednesday

Friday (a la carte)

None

Which a la carte classes are you interested in? *

Art

STEM

Cooking

Spanish (Coming Soon!)

Fitness Fun

Origami

None

What is your preferred start date? *

Q1- August

Q2- October

Q3- January

Q4- March

Summer Session

Immediate/As soon as possible

Student #2 Name

First Name

Last Name

Student #2 DOB

MM

DD

YYYY

Parent Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Referred by

If you were referred by someone, please enter their name here.

First Name

Last Name