Clubs & Activities Registration

1 Student Information

2 Billing and Payment Information

Clubs
Student's Name*

First

Last
Choose a Club or Activity*
- Soccer Club (Grades 3-6)
- Middle School Robotics Club (Grades 6-8)
- Middle School Literary Magazine (Grades 6-8)
- Chess Club (Grades 3-6)
- 6th - 8th Grade Soccer Club (Grades 6-8)
- SAT & ACT Math (Grades 9-12)
- Yoga Club (Grades 2-3)
- Volleyball Club (Grades 6-8)
Student Grade
Total
$0.00

Name

First

Last
Email
Address

Street Address

Address Line 2

City

State

ZIP Code
Phone
Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code

Cardholder Name