Student Registration Form

Children Program Registration Form 2025-2026
PARENTS/GUARDIANS INFORMATION

Mother/Guardian Information
Mother's Full Name*

Mother's First NameMother's Maiden NameMother's Last Name
Mother's Phone Number*
Mother's Email*
example@example.com
Mother's Home Address*

Street Address

Street Address Line 2

CityState

Zip Code

FATHER/GUARDIAN INFROMATION
Father's Name*

Father's First NameFather's Last Name
Father's Phone Number*
Father's Email*
example@example.com
Father's Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

PRIMARY CONTACT
Who do you wish to be the primary contact to receive our school emails and messages?*

MotherFatherBothOther

EMERGENCY CONTACT INFORMATION
Emergency Contact*

Emergency contact's First NameEmergency contact's Last Name
Emergency Contact Relationship to Student*
Phone Number Of Person To Contact In Case Of Emergency*
Please enter a valid phone number.
Email Of Person To Contact In Case Of Emergency*
example@example.com

STUDENTS INFORMATION
How many Students would you like to register?*

12345

PAYMENT METHOD
Please verify that you are human*
Select a Payment Method*

Pay ONLINEPay by CHECK or CASHZelle

PAY ONLINE

Please select one or both options below and proceed with your payment

1 Child Registrationfor 1 child only

$300.00 Quantity
Item subtotal:$0.00

Total

$0.00

Credit Card

(Once submitted, you will be redirected to fill the Liability Release Forms for 2025-2026, valid for Children Program Participants & MYO)

PAY BY CHECK OR CASH ($300.00/Child)
Name of Payee

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
The amount due is $
(Once submitted, you will be redirected to fill the Liability Release Forms for 2025-2026, valid for Children Program Participants & MYO)

PAY BY Zelle ($300.00/Child)
You can send the payment to the following number:

+1 (310) 614-8188

Kindly leave a note with the name(s)of your registered child(ren).
Please provide the name associated with your Zelle account.
The amount due is $
(Once submitted, you will be redirected to fill the Liability Release Forms for 2025-2026, valid for Children Program Participants & MYO)
Should be Empty: