SixTwelve After School Adventure Registration

This program is currently full, but if you'd like to be placed on the waiting list, please fill out this form and we will let you know when spaces open up. Thank you so much!

Student's Name *
Student's Name
Birth Date of Student *
Birth Date of Student
Parent or Gaurdian Name *
Parent or Gaurdian Name
Parent or Guardian Address *
Parent or Guardian Address
Parent or Guardian Phone *
Parent or Guardian Phone
Please indicate Tuesdays, Wednesdays and/or Thursdays.