Fall 2021 Registration
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Student Name *
Student date of birth and current age *
Parent/Guardian Name(s) *
Parent/Guardian 1 Cell Phone Number *
Parent/Guardian 1 Email *
Parent/Guardian 2 Cell Phone Number
Parent/Guardian 2 Email
Home Number (if applicable)
Mailing Address *
Student Email (if applicable)
Student Phone Number (if applicable)
Student's School/Grade *
Emergency Contact Name & Relationship to Student *
Emergency Contact Phone Number *
Please list below any of the student's allergies, medical conditions, or medications.
Primary Care Provider *
PCP Phone Number *
Insurance Provider *
Member Name
Policy ID
Indicate below the average level of class your student was registered for last season. Please note that level recommendations for this year are the same as last year (unless you have already been notified otherwise). Everyone's training was interrupted by COVID so we will use the first two weeks of classes to ensure appropriate leveling. If splitting please select 2. (Beg=1/2, Int=3/4, Adv=4/5) *
Required
Please select the classes you would like to register for *
Required
Please add up the hours for all classes selected above and put the total below. (Note that there will be some odd numbers due to small gaps between classes for cleaning) *
You will receive a registration confirmation email. There will be a safety waiver attached that must be completed, signed, and returned to Project C before your student can participate in class. Please click below to indicate you understand. *
Upon receipt of this registration form we will check to make sure each student is placed in the correct classes. You will then be contacted via email with a link to an online portal where you can submit payment. Please click below to indicate you understand and agree *
Click below to indicate you have read and understand our tuition breakdown and policies (attached to the registration email) *
Please note that our schedule has been made based on the current schedules for public schools and is therefore subject to change. If a future conflict creates a need for a change in registration we will help you resolve it. Click below to indicate that you understand. *
How did you hear about Project C? Please only answer if you are new with us this season. If you were a personal referral, please let us know who told you about us!
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