* Indicates required fields

        Parent Name:            *  

        Street Address:          *  

        City:                          *      *State:       *Zip:  

        Primary Phone:          * ()-

        Alternate Phone:           ()-

        Emergency Phone:     * ()-

        email                         *  

        Children to be Enrolled: (classes available for 3yrs-rising 6th grade)

            Name                                                         Date of Birth                    Grade Next Fall

            Are there any special needs that your child has?  Any allergies?

            What, if any church, do you currently attend regularly?

    ** A Craft Fee of $10 per child is due at registration. **