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The Green Room Student Application Fall 2024
This form is to register for the 2024-2025 school year at The Green Room Learning Community. To secure your spot, please pay your application fee of $25 to Renaissance Kids (129 Burton St. A, Anchorage, AK 99504) or at Venmo TheGreenRoom@renaissancekids. This is an early registration form, so we may need you to fill out a more detailed form at a later date. 
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Student full name *
Grade Level in September 2024 *
Student Date of Birth *
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Student Email
Student Phone Number 
Address *
Primary Parent/Caregiver - Relationship to Child *
Primary Caregiver Phone Number *
Primary Caregiver Email Address *
Secondary Parent/Caregiver - Relationship to Child
Secondary Caregiver Phone Number
Secondary Caregiver Email Address
To what school does your child belong?  *
What part(s) of our program are you interested in?  *
Required
Payment Information: 
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If you are part of an allotment program, please write the name of your sponsor/advisory teacher below. 
What location would you prefer? 
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May we use photos of your student for marketing purposes?  *
Would you like your name and contact info placed on our carpool list for parents? 
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Please describe any special needs your child may have and your goals or hopes for this upcoming school year. 
Who referred you to this program or how did you hear about us? 
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