Schooly Groove Enrichment Programs

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REGISTRATION FORM

Untitled Title

Program Requested

Student Name *

Full Name

School *

Enter the school your child attends

Teacher/Rm # *

Birthdate *

YYYY

Sex *

Female

Male

Parent's Name *

Grade *

Address *

City *

State *

Zipcode *

Home Phone

Cell Phone

Emergency Contact *

Parent's Email Address *

Dismissal

Parent Pick-up

Walk

Child Care

Clear selection

Special instructions or needs

Liability Acknowledgement With submission of this registration form, I acknowledge my commitment to the requested class and time, accepting the applicable tuition debt. I further understand that tuition becomes non-refundable after class 2 of the session. Late registrations are accepted after the start of the session at full tuition cost. No prorated tuition available. By signing this form, parent/guardian is aware of risk involved in enrichment activities and does not hold Schooly Groove Enrichment or subsidiary, responsible for any injury that may occur. *

Parent or guardian name:

Submit

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