Enrollment

Student Name *

Grade *

School *

Parent/Guardian Name *

Phone Number *

Email *

Emergency Contact Name *

Emergency Contact Phone Number *

Program Selection *

Early Literacy ( K-1 )
Ballet Dance ( 2-3 )
Technology ( 4-5 )
Visual Arts ( 6-7 )

Medical Concerns/Allergies: *

Photo/Media Permission *

Yes
No

Parent Signature (Print Name) *

Today's Date *

School Name *

District *

School Adress *

Principal *

Contact Person *

Title *

Phone Number *

Email address *

Grade Levels Served *

Estimated Number of Students *

Preferred Program Dates *

Summer 2026 Semester
Fall 2026 Semester
Spring 2027 Semester

Preferred Days/Times *

School Goals for Partnership *

Additional Information *

Signature (Print Name) *

Today's Date *