Registration Form

Please complete a separate registration form for each child. there is a 25% Sibling Discount.  Registration is on a first come, first serve basis. By submitting this form it does not guarantee enrollment. we will not run your credit card until we have a phone conversation with you to go over all the details. 

Student *
Student
Select which day(s) you would like your child to attend: *
Transport is included in the monthly cost for the after school program.
Pick-up time from School?
Pick-up time from School?
Technology Workshop Tracks
Please select 2 - 3 technology tracks you would like your child to focus on throughout the year. You can change tracks in the middle of the year.
Parent/Guardian *
Parent/Guardian
Home Phone
Home Phone
Parent Cell Phone:
Parent Cell Phone:
Home Address
Home Address
Please provide us with the Name(s) & Phone numbers of family/friends to call in case we can't reach you.
Payment Information
If you have a promocode we will apply the discount when we run your card.
Please enter the monthly amount to be charged on your card. $122 - 1 Day per Week $221 - 2 Days per Week $299 - 3 Days per Week $355 - 4 Days per Week $389 - 5 Days per Week
$
3 or 4 Digit Code on Back of Card.