Spring 2022 Registration Form

Student's Name*
Grade #*
Child's Date of Birth*
Class #
Parent's Name*
Parent's Name
Phone (Day)*
Phone (Evening)
Email*
Cell Phone*
Allergies or Special Medical Conditions
Additional Emergency Contacts
Pediatrician's Name*
Pediatrician's Phone*
Please list the class desired, the day and time, and the amount*
*Additional forms may be required after the selected classes are confirmed. *We will be in touch with you via email to confirm place in class.
Additional Information
Your Name*
First Last
Relation to Child*
Date*
MM slash DD slash YYYY
The following people are authorized to pick up my child:
Name
Name
Name
It is responsibility of the Parent/Guardian to notify Aurora Skills, in writing, if someone is not legally permitted to pick up your child(ren) from our programs. Prior notification must be given to Aurora Skills if someone other than the approved person/s listed above will be picking the child(ren) up after the program.

Additional Information