register-form2

Level 2 Registration Form

Register for the Fall Semester Level 2 course here. Lessons are on Thursdays, 5:30pm - 7pm from October 14 to November 22. Students must be age 9 through 17.

This form is for the Level 2 course. Register for the Level 1 course at this link.
Level 1 is a prerequisite for this course.

Parent/Guardian Information

* Indicates required field

Name of Parent/Gaurdian *

First

Last

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency Contact (If different from guardian)

Name *

First

Last

Phone Number *

Email *

Student Information

Name of Boy *

First

Last

Nickname (if applicable) *

Age *

School *

Relevant Health Conditions/Allergies? *

Media Consent Form

As a parent or guardian of this student, I hereby consent to the use of photographs/videotape taken for publicity, promotional and/or educational purposes (including publications, presentation, social media, internet or other media sources). I do this with full knowledge and consent and waive all claims for compensation for use, or for damages.

Pick One *

Yes No

Additional Comments *

Submit

Level 2 Registration Form

Parent/Guardian Information

Emergency Contact (If different from guardian)

Student Information

Media Consent Form

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