PH Registration

PERFORMING HEARTS REGISTRATION

Registration Deadline: August 31, 2019

$50 registration fee is required at the submission of this form.

* Indicates required field

CHILD'S NAME *

AGE *

BIRTHDATE *

TSHIRT SIZE *

TEACHER *

SCHOOL *

Allergies/Medical/Emotional/Special Needs *

Parent/Guardian Name *

Parent/Guardian Email *

Parent Phone *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Names of those authorized to pick up your child *

Pick-up from Performing HEARTS will be in the normal car rider line at 12:20 p.m. if student is not staying for play day. Please have your BMK car-rider tag visible. THANK YOU FOR HELPING US KEEP YOUR KIDS SAFE! Classes begin the week of September 2.

ATTENTION: When you click "submit," you will be led to a page where you will pay the $50 deposit. Please do not click submit until you are ready to do so!

Submit