Class Registration

Parent name *

Phone number *

Email *

Child information

Child's name *

Age: years *

Birthdate * +

Does the child have any allergies? If so, please explain.

Emergency contacts

Emergency contact 1 name *

Emergency contact 1 phone number *

Relationship to child *

Parent

Neighbor

Friend

Family member (please indicate relationship) Family member (please indicate relationship)

Emergency contact 2 name *

Emergency contact 2 phone number *

Relationship to child *

Parent

Neighbor

Friend

Family member (please indicate relationship) Family member (please indicate relationship)

Services

Select your class below...
***All classes listed below are $125 for 6 weeks***
Fall 2 session runs from the week of November 1st through December 16th
NO CLASSES the week of November 20th
Due to limited spacing, registrations are not complete until payments are made

Payments can be made via Paypal on the registration form or venmo @ColleenShea83
Please put childs name in memo *

Tuesday After School meet-up 3:30 -5pm

Tuesday Homeschool meet-up 1-2:30pm

Thursday Homeschool meet-up 1-2:30pm

Friday Tween/Teen meet-up 2-3:30pm

Free Trial

I agree to have my/my child's picture posted to social media *

yes

Waiver terms and conditions *

I have read and agree to the waiver, terms, and conditions posted at the bottom of Carolinaktt.com

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