Please Fill Out the Form to Register Your Child

Please enter YOUR information below

First Name *

Last Name *

Cell Phone *

(Compliance) Text Checkbox

By checking this box I agree to receive email and SMS text communications and promotions from BTWA approximately 4 messages a month. SMS text and data rates may apply. I may opt out at any time by replying STOP. View Terms and Conditions at the bottom of this page.

Email *

Address *

City *

State *

Zip code *

Child 1 Full Name *

Child 1 Date of Birth *

Child 1 Gender *

Male

Female

Child Shrt Size

4/5 (Sm)

Child Photo

JPEG, JPG, PDF or PNG

Child 2 Full Name

Child 2 Date of Birth

Child 2 Gender

Male

Female

Child T-Shirt Size

Child 3 Full Name

Child 3 Date of Birth

Child 3 Gender

Male

Female

In addition to those listed above, the following individuals may pickup my child:

1.
2.
3.
4.

To keep our summer program running smoothly, please agree to all of these policies:

I agree to pay the weekly tuition by the first class of each week, as well as the non-refundable registration fee to reserve my child’s place and pay for his/her school supplies.

I give permission for my child’s photograph(s) and/or videotaping(s) to be used for our summer program marketing materials offline and online, newsletters, and art projects.

I agree to abide by the Policies & Procedures Handbook which will be explained to me during our meet & greet.

Parent Agreement *

I agree to all of the policies listed on this form.

Parent Signature

Clear

Date Signed

website: beyondthewalls-academy.com

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