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Please fill out the form below to register. Required fields are denoted by an *.
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Student Information
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Name*
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First*
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Last*
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Grade Level*
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During the 2012-2013 school year:
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Birth Date* |
[MM/DD/YYYY]
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Gender* |
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School District*
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School Building*
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Medical Information
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List allergies, medical conditions, or special needs related to indoor or
outdoor activities.
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Parent/Guardian Information
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Name*
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First*
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Last*
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Street Address*
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Include any apartment/suite numbers.
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City
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State Zip Code
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Phone*
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Primary*[(xxx) xxx-xxxx]
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Alternate [(xxx) xxx-xxxx]
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Email Address*
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Authorized Pickup Persons*
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List persons who should be allowed to pickup your child from WINGS. (Including yourself)
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Emergency Contact (Other than yourself)*
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Name*
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First*
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Last*
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Phone*
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Primary*[(xxx) xxx-xxxx]
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Alternate [(xxx) xxx-xxxx]
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Class Selections |
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In order to attend during the lunch period, your child must attend BOTH the AM
and PM session that week.
The lunch hour is supervised.
(popup)
Please select each class only once. Classes listed below are currently
available.
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You will not be able to view or select classes until you have
indicated your child's grade level above.
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Cost |
0
Class(es) x $55/class =
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$0.00
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0
Lunch(es) x $21/lunch =
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$0.00
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Total =
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$0.00
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Carpooling Information*
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Please choose whether you are interested in carpooling below. If you are, we'll connect you with parents who are interested in your local area. Only the Parent Name, Email Address, and Phone Number will be shared with other parents.
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Scholarship Information*
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Scholarships are available to students who qualify for Free or Reduced Lunch.
If you qualify for and request a scholarship, you will receive a 50% discount on
tuition. No discount is provided for lunch.
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Photo Release*
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Survey - Please answer the survey questions below.
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Where did you hear about the WINGS program?
(Please choose the option that was most useful or convincing for you.
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Would you be interested in purchasing WINGS merchandise, like a T-Shirt?
Answering this question does not commit you to buying a T-Shirt.
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Agreements - Check all boxes below.
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Submission
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A confirmation screen detailing instructions on
submitting payment will be shown after you submit this registration.
You will not be able to return to this page. If you would like to print
a
copy, you must do so before clicking on the 'Submit' button.
An email will also be sent to the address entered above.
All confirmations and notices will be sent via email.
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The "Submit Registration" button will be active after you have agreed to the statements above.
Please click this button only once.
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