Kids Express Registration

Please fill out this form to register you child/children for Kids Express classes.

Contact Information * required

First Name *

Last Name *

Contact Phone *

Home Phone

Mobile Phone

Email

Street *

City *

State *

Postal Code *

Location & Contact # on Wednesday Nights: *

Dismissal Information *

As a matter of safety, we will not be allowing children to self-dismiss this year. Please list three individuals allowed to retrieve your child(ren):

Child #1 Name: *

Date of Birth: *

Grade & Age: *

If this child is in 1st- 5th grade, please indicate whether they would like to be a part of Kids Express (the musical production), or Kids Express Too (the alternative for kids not interested in performing)

Child # 2 Name:

Date of Birth:

Grade & Age:

If this child is in 1st- 5th grade, please indicate whether they would like to be a part of Kids Express (the musical production), or Kids Express Too (the alternative for kids not interested in performing)

Child #3 Name:

Date of Birth:

Grade & Age:

If this child is in 1st- 5th grade, please indicate whether they would like to be a part of Kids Express (the musical production), or Kids Express Too (the alternative for kids not interested in performing)

Child #4 Name:

Date of Birth:

Grade & Age:

If this child is in 1st- 5th grade, please indicate whether they would like to be a part of Kids Express (the musical production), or Kids Express Too (the alternative for kids not interested in performing)