Parent *

First Name

Last Name

Child #1 / Superfish Name *

First Name

Last Name

Child #1 Birthday *

MM

DD

YYYY

Child #2 / Superfish Name

First Name

Last Name

Child #2 Birthday

MM

DD

YYYY

Preferred Lesson Days *

On Mondays and Wednesdays

On Tuesdays and Thursdays

Preferred Lesson Times *

7:45am - 10am

10am - 1pm

2pm - 4pm

4pm - 7:45pm

Email Address *

Phone *

(###)

###

####

Preferred contact method *

Email Phone

Notes

any additional info...