Child Registration Form

Please fill out the form for each student registering

Note: You have the option to print the Child Registration Form

STUDENT NAME (First/Last) *

PARENT/GUARDIAN NAME (First/Last) *

STUDENT BIRTHDATE *

PARENT/GUARDIAN EMAIL *

ADDRESS (Street/City/State/Zip) *

TELEPHONE NUMBER

CELL PHONE NUMBER *

Emergency Contact Information

Provide local person(s) to be called in case the parent/guardian cannot be reached:

Emergency Contact Name 1: *

Emergency Contact Name 2:

Phone Number 1: *

Phone Number 2:

Medical History

Does your child have allergies or medical condition(s) that the school needs to be aware of? *

Yes

If yes, please list allergies or medical condition(s) your child has:

(Note: Teachers are not authorized to administer medicines or provide medical related services.)

Medical Treatment

If the parent/guardian cannot be reached in case of serious injury or illness, I authorize the school to take such emergency action necessary, including the transportation of the student to a hospital or medical center. As a parent/guardian, I authorize treatment by a qualified and licensed medical doctor of the above listed minor(s) in the event of a medical emergency. This authority is granted only after a reasonable effort has been made to contact me

Signature Agreement:

By checking this box, I agree to the use of my electronic signature and agree that the electronic signature is valid and has the same effect as a written signature on a paper copy of this document.

Print name of parent/guardian *

Date *

Parental Consent and Release or Public Relations, Internet/Website Information

Media Authorization *

I authorize the above child’s name, images or video to be used in print or the school website for the sole purpose to recognize an achievement of the child or for the promotion of the school.

I do not authorize the above child’s name, images or video to be used in print or the school website for the sole purpose to recognize an achievement of the child or for the promotion of the school.

Student's Tuition

$400.00Add to cart

Annual Snack Fee

$40.00Add to cart

* Remember to pay for your student's tuition after submitting the Registration form by viewing the cart.

Use Promo code at checkout:

Promo Code for 2 Students: 2STUDENTSGLS50

Promo Code for 3+ Students: MULTISTUDENTSGLS150

Thank you for registering your student for the school year 2023-24. The registration form has been submitted.

There was an error trying to send your registration form. Please try again later.