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REGISTRATION

* Indicates required field

CHILD'S NAME *

PARENT or guardian'S Name *

AGE *

Phone Number *

Email *

EMERGENCY CONTACT *

RELATIONSHIP TO CHILD *

Phone Number *

Health or physical restrictions I should be aware of? *

Child's preferences *

Questions/Comments *

Once you have completed the registration, you will receive a confirmation from me via email.

permission___disclaimer_winter_2018.odt

Please download and sign permission form and send with your child's tuition to

Jessica Schroeder,
168 Bridge St. #1,
Salem, Ma 01970

There is a 10 student minimum for this program. If the minimum is not met, and tuitions collected by 1/15/18, the program will be canceled.

Thank you
Jessica Schroeder

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