Musical, Moveable Me Registration

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Child's Name Child's Name First Last
Child's Age
Child's Grade
Child's Gender

Child's Gender Male Female
Allergies?

Allergies? Yes No

NOTE: Children with allergies MUST have a completed Allergy Action Plan.
Parent's Name Parent's Name First Last
Parent's Phone Number Parent's Phone Number - ### - ### ####
Parent's Email Address

A confirmation of this registration will be sent to this e-mail address.
Is Parent an Academy Employee?

Is Parent an Academy Employee? Yes No
Emergency Contact Emergency Contact First Last
Emergency Contact Phone Number Emergency Contact Phone Number - ### - ### ####
After clicking Submit below, please wait to be redirected to online payment.
$0

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