Classes Registration (2022-2023)

Classes Registration Form
I am registering for...*
Please check the box below if you are re-enrolling a current participant for the next session of this class.

I am re-enrolling a current participant.

Registration Information
Parent/Guardian's Name (if applicable)

First NameLast Name
Please select the number of children who will be participating in the class.*
Student's Name*

First NameLast Name
Student's Date of Birth*

MonthDayYear
Date
Second Student's Name*

First NameLast Name
Second Student's Date of Birth*

MonthDayYear
Date
Third Student's Name*

First NameLast Name
Third Student's Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number (to be contacted on day of class)*
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Primary Language Spoken at Home*
Accommodations: We strive to create an environment in which all students feel comfortable getting creative and have a successful class experience. Please share any other information you would like us to know. You can write "call me" and we will contact you for more information.*
Medical Information

We collect medical information for all in-person and virtual services. The information provided would be used should we need to contact emergency services during your child's time with us.
Please list any allergies (parent):*
Do you have an epi-pen?*

YesNo
Does {namestudent1} have any allergies? List below.*
Write "N/A" if none.
Does {namestudent1} have an epi-pen?*

YesNo
Does {namestudent2} have any allergies? List below.*
Write "N/A" if none.
Does {namestudent2} have an epi-pen?*

YesNo
Does {namestudent3} have any allergies? List below.*
Write "N/A" if none.
Does {namestudent3} have an epi-pen?*

YesNo
Medical Attention
In the event of an emergency requiring medical attention, I understand that Sing Explore Create, LLC will make every effort to contact and notify the listed parent/guardian and emergency contact listed above. However, if neither can be reached Sing Explore Create, LLC reserves the right to call emergency personnel to transport the student/client to the nearest medical facility to secure necessary medical treatment. This applies to sessions at our center, at-home visits, and online sessions.*

I have read and agree to the above statement regarding medical attention.
Emergency Contact
Emergency Contact Name*

First NameLast Name
Emergency Contact Relation to Student*
Emergency Contact Phone*
Please enter a valid phone number.

Participant Name*

First NameLast Name
Email Address*
example@example.com

Classes Registration Form

Registration Information

Medical Information

Medical Attention

Emergency Contact

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