The School | The Academy | The Foundation | The Fellowship | The Experience
Student Name: ______________________________________________________________________________
Age: _______ School: ____________________________________________________ Grade: _________
Parent Name: _______________________________________________________________________________
Mailing Address: _____________________________________________________________________________
City/ State: _________________________________________________________________________________
Email Addres: _______________________________________________________________________________
Telephone: ____________________________________ Cell: ________________________________________
Emergency Contact Information:
Contact Name: _______________________________________________________________________________
Address: _____________________________________________________________________________
Contact Number: _____________________________________________________________________________
Select Program(s):
[ ] ART
[ ] DANCE
[ ] MUSIC
Program Fee: $100.00 Per Program/Per Child (The fee can be broken up to $20 a week)
*If the parent has multiple children attending please ask the administrator about sibling discount.
Parent Signature : ___________________________________
SUBMIT NOW
