Registration

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

(###)

###

####

What is your student's name? *

If registering multiple students, please fill out a form for each student.

First Name

Last Name

Which days a week are you interested in sending your student to The Anchor?

Select all that apply.

Monday

Tuesday

Wednesday

Thursday

Friday

How many hours of attendance at The Anchor each day?

4 hours (1/2 day)

7 hours (full day)