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Enroll Today

After School Care Enrollment 2018-2019

Student's Name*

Address

City/Zip*

Date of Birth*

School Grade for 2018-2019*

School Attending*

Email Address*

Parent(s) Name(s)*

Primary Phone Number*

Secondary Phone Number*

What Type of Care Do You Need?

Full timePart time

Allergies/Medical Conditions

How Did You Hear About Us?*

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Dance/Karate Registration

Student's Name*

Address

City/Zip*

Date of Birth*

Age

Prior years of dance/karate experience

Email Address*

Mother's Name

Mother's Cell Number

Father's Name

Father's Cell Number

What class(es) are you enrolling in? *

How did you year about us?

Emergency Contact Other Than Parent

Emergency Contact Phone Number

Allergies/Medical Conditions*

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Thank you for contacting us. We will get back to you as soon as possible