Registration
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Student’s Name
 *
Students Address *
Students Date of Birth
MM
/
DD
/
YYYY
Phone Number *
Students Email *
Gender
Parent/ Guardian's Name
Relationship to Child
Address
Phone Number
Email
Parent/ Guardian's Name
Relationship to Child
Address
Phone Number
Email
Authorized Person(s) for pickup: Name/cell number
 *
Ethnicity which best describes your predominant race
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Does your child have any Food allergies
Medical issues
Did your child take the Covid vaccine? (Some activities/field trips will required proof of vaccination or negative Covid-19 test results in last 72 hours in order to participate)

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Group enrollment is normally limited to 7-15 per group (depending upon the ages & staff as smaller groups sizes allows us to connect with every participant). All children accepted into our program are placed on a waiting list for an upcoming group. We work very hard to compose groups of children who are in approximately the same social level. In some cases this may mean waiting a little longer for an appropriate group. 


Groups will usually fill up at least six weeks before the start date of a new program. Please contact us in advance to complete your phone screen and receive your enrollment packet. The date of your appointment determines your spot on our wait list. 

                   *You may also schedule one-on-one classes*


Programs are housed in a variety of local physical spaces through our partnerships. Possible locations: schools, libraries, recreation centers, churches, parks, childcare centers, or


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