Student Name #1

First Name

Last Name

Student Name #2

First Name

Last Name

Student Name #3

First Name

Last Name

Parent Name *

First Name

Last Name

Phone

(###)

###

####

Lego Club *

Please choose if you would like to register for 4 months for a discounted rate or drop in

Four Month Pre-Paid $135 ($25 discount)

Drop-in September 20th

Drop-In October 18th

Drop-In November 15th

Drop-In January 17th

Payment Option *

Please select which payment option you would like to use.

Cash or Check

Venmo (Twani Capelli @Cedar Hill Academy)

I agree to allow my child’s name and photograph to be included in Cedar Hill Academy publications and in information shared with the media and\or social media accounts. *

Yes

No

Does your child have any food or environmental allergies? *

Yes

No

I would like to be added to the Cedar Hill Academy email list to recieve future camp and class announcements, new and tips! *

Yes, please!

No, thank you anyway.