Ignite Registration

Please fill out the form below to register your child for our after-school program, Ignite.

Child's Name *
Child's Name
Parent or Guardian 1 *
Parent or Guardian 1
Parent or Guardian 2
Parent or Guardian 2
Home Address *
Home Address
Cell Phone *
Cell Phone
Work Phone
Work Phone
Home Phone
Home Phone
Emergency Contact #1 *
Emergency Contact #1
Emergency Contact #1 Phone *
Emergency Contact #1 Phone
Emergency Contact #2 *
Emergency Contact #2
Emergency Contact #2 Phone *
Emergency Contact #2 Phone
When is your child's birthday? *
When is your child's birthday?