Enrollment Form

Please fill out a complete online form for each student you wish to register. Two or more students require two or more complete form submissions.

Check or Credit Card (V,MC,D) payment must be received within seven (7) days of registration. Consult Tuition Schedule to determine correct payment due. All new students must add an annual $35.00 Registration fee. If unsure as to amount, please call or email us to assist.

Bolded form fields are required to be completed.

Student Information

First name:

Last name:

Date of Birth:

Gender: Male Female

Parent/Guardian Information

First name:

Last name:

Address:

City or Town:

State:

Zip Code:

Contact information

Home Phone:

Alternate Phone:

Email:

Hear About Us?:

Term|Course|Class Selection

Term/Camp:

Course:

Class/Time:

Tuition($):

Emergency Contact Information

Contact name:

Contact Phone:

Doctor Name:

Doctor Phone:

Allergies:

Policy|Medical|Photo Approvals I have read and understand the 2010 Renaissance registration and enrollment polices. I give permission for my child to receive medical attention in the event of an emergency. I give permission for my child's photo to be used for Renaissance promotional media (without full name).