After-School Program

Your Name*
First Last
Home Phone*
Mobile Phone
Email*
About Your Child
If you are registering multiple children, you must fill out a separate form for each.
Child's Name*
Child's Age*
Additional Info
School Name
I'm Interested in After School Classes on the following days:*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
What are your child's strengths?
How do you know us?*
- Google'd it!
- In After School or Daycare Program
- Attended/Hosted a Birthday Party
- Facebook.com/KidsImaginarium
Additional Notes:

About Your Child