Parent & Me Registration

Name (Parent's)

This address will receive a confirmation email

Phone

Address

Child's Name

Child's Date of Birth

Child's favorite activity

Child's favorite snack and drink

Allergies

Emergency Contact

Will someone else be bringing your child to the class? Please provide their information if different than guardian

Payment $250

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Please fill out this form and click submit.