Enrichment Registration Name * First Name Last Name Date of Birth MM DD YYYY Parent/Guardian Name(s) First Name Last Name Phone * (###) ### #### Mailing Address Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Allergies: Emergency Contact: Register for the following program(s) Junior Wings 10 Installments 1 Class: $77 2 Classes: $138 3 Classes: $179 Senior Wings 1 Class: $91 2 Classes: $164 3 Classes: $215 4 Classes: $267 Jr. Reading Jr. Art Jr. Kids in Motion Sr. Reading Sr. Art Sr. STEM Sr. Mindfulness Thank you for choosing Kids Club House!