REGISTRATION FORM
Please print and mail this form to 112 Buchanan Dr., York, Pa 17402.

Child's name:
__________________________________________________________

Street address:
__________________________________________________________

City and ZIP code:
__________________________________________________________

Phone number:
__________________________________________________________

Emergency phone number:
__________________________________________________________

Child's birthdate and gender:
__________________________________________________________

Any medical conditions we should be aware of?
__________________________________________________________

Class choice:
__________________________________________________________
Deposit paid:
__________________________________________________________
Balance due:
__________________________________________________________

Parent's signature:
__________________________________________________________

Parent's name (please print):
__________________________________________________________