Enrollment Form

Student’s Name________________________________________________________________

Parent’s Name_________________________________________________________________

Telephone: Home:_____________________________________________________________

Telephone: Cell:_______________________________________________________________

Allergies or Food Restrictions:____________________________________________________

Emergency Contact:____________________________________________________________

Important information about your child:____________________________________________

_____________________________________________________________________________

I will do my best to bring my child to class on time and will not hold you responsible for any injury that my child may inflict upon him/herself. J

Parent Signature & Date:_________________________________________________________