Class Registration Signup Form

Wildhood Student Registration Form

To be completed after communication with Wildhood. The required $50 enrollment deposit will be deducted from the first tuition payment. A receipt will be emailed through Stripe, our secure processing service. *Please note that we are currently enrolling for our wait list - new students will be registered for the 2018/2019 school year or as space becomes available.
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Ethnicity
1. Parent/guardian

First NameLast Name
E-mail
Preferred days of enrollment: Check all that you wish to enroll your child. Please note that days of enrollment depend on availability.

MondayTuesdayWednesdayThursdayFriday
Would you be interested in alternative days, if one or more of your preferred days is not available?

YesNo, my other days are full
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
2. Parent/guardian

First NameLast Name
email
Address (leave blank if the same)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Student allergies and medications
Emergency contact(s)
I authorize the other adults listed to pick up my child. Please include phone number and relationship to child.

Enrollment deposit *

new student deposit $50.00

Wildhood Student Registration Form