Enrollment Request Form

Your Name

First Name

Last Name

Phone Number

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date You Would Like to Attend

YYYY

Your Child's Name

First Name

Last Name

Your Child's Birthdate

YYYY

Does your child have any allergies? If so, please list.

Emergency Contact (other than yourself)

First Name

Last Name

Emergency Contact Phone Number

Anything else we should know about?

Coastal Kids email list

Sign me up!

Please review our program policies, including what to pack.