Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Child's First & Last Name *FirstLastChild's Date of Birth *Gender *FemaleMaleSpecial Physical/Social/Emotional Needs *AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent/Guardian InformationParent/Guardian #1 Name *FirstLastParent/Guardian #1 Phone *Parent/Guardian #1 Email *EmailConfirm EmailParent/Guardian #1 Employer *Parent/Guardian #2 Name *FirstLastParent/Guardian #2 Phone *Parent/Guardian #2 Email *EmailConfirm EmailParent/Guardian #2 Employer *Class Preference SelectionPlease select your 1st and 2nd choice of class.Class Selection - 1st Choice *Option AOption BOption COption DOption A: T/Th: 8:30-11:00 $90 | Option B: MWF: 8:30-11:00 $130 | Option C: M-Th: 12:30-3:00 $165 | Option D: M-F: 8:30-11 $200Class Selection - 2nd Choice *Option AOption BOption COption DOption A: T/Th: 8:30-11:00 $90 | Option B: MWF: 8:30-11:00 $130 | Option C: M-Th: 12:30-3:00 $165 | Option D: M-F: 8:30-11 $200Submit