Student Registration
Thank you for registering for our event. If you have questions, feel free to reach us at 203-245-2689 or email:
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Student's First Name *
Student's Last Name *
Gender (preference/pronoun) *
Date of Birth *
Grade *
Student's NON-SCHOOL Email: *
These emails will be added to our constant contact list to notify you of events and updates, as well as important information about this event/program. If you prefer to not be added, please let us know at PLEASE DO NOT ENTER A SCHOOL EMAIL.  If you would like more than one email address on the notification list please list all of them here
Alternate Email (can be parent)
Student's Cell Phone Number *
If Student does not have a cell phone number, please use parent's cell.
Parent/Emergency Contact: Name *
Parent/Emergency Contact: Cell Number *
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