STRIPES 360 2021-2022 Registration Form
Please complete this form to register for Tiger STRIPES, Tiger PALS, or Tiger TEENS. Do not use this form for enrollment changes. If you need to make a change to your enrollment status please contact the STRIPES 360 Office.

Registrations are processed Monday- Friday.
Please note, all new enrollments start the following week, make sure your start date is indicated correctly.
Within 1-3 business days from you registering you will receive an invoice from Procare, STRIPES 360's billing software for your student's non-refundable enrollment fee and tuition fees.
Please email stripes360@republicschools.org with any questions.

NOTE: This form must be completed for each student you need to attend programming.

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Email *
Student First Name *
Student Last Name *
Gender *
Birth Date *
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DD
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School *
Grade (2021-2022) *
Student Health Information
My child is in good health. *
Does your student have allergies or special medical conditions, including chronic health problems?
Does your student have a disability, behavioral need, or developmental need?
Does your child have a current IEP, 504 Plan, or Behavior Intervention Plan through the Republic R-III School District?
Doctor/Clinic (Name & Phone Number) *
Preferred Hospital *
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