Online Registration

Your Name (required)

Full Address, City & Postal Code

Primary Phone Number & Name

For the above question

Cell? Texting? 

Secondary Number

For the above question

Cell? Texting? 

Your Email (required)

Alternate Emergency Contact Name & Phone Number

Is there anyone else who will be picking up your child?

Yes? No? 

If Yes, Please give their Name, Relation and Phone Number?

Allergies

Student's Name

Age

DOB:

Grade

Session I or II

Session I Session II 

Before Care? Time 7:00 - 8:15

Yes No 

Class 1? 8:30 - 10:15

Class 2? 10:30 - 12:15

Class 3? 1:15 - 3:00

Aftercare? Time 3:00 - 6:00

Yes No 

Subject

Your Message


Do you know 100% for sure you are going to heaven?