* denotes a required field

    Student Name*

    Student's Age/Grade*

    Home Address*

    Home Phone*

    Second Student Name

    Second Student's Age/Grade

    Parent or Guardian Name*

    Cell Phone*


    Other Parent or Guardian Name

    Parent's Occupation

    Cell Phone


    Please let us know if your child has any health issues we should be aware of

    Which classes are you registering for?*

    Photo and video permission: By checking this box, I understand that photographs or videos may be taken of students (not including the name) during class and / or performances. I agree that the school for publicity purposes may use such images.*

    Parent's Digital Signature*

    Date* (DD/MM/YYYY)

    Notes or Comment