Newhart Middle School Program

Information

Schedule

Registration

Please fill out and submit this form.

One child per form please.

Parent or Guardian First Name:
Parent or Guardian Last Name:
Home Address:
City:
State:
Zip Code:
Contact Phone Number:		Ph. Type:
Contact Email:
Child's First Name:
Child's Last Name:
Child's Age:
Child's Date of Birth:
T-shirt size:
How did you hear about our program?
Other or family who referred you:
Child's School:
Child's Start Date:

If you are signing up for a three day week, please choose your days below

Mondays

Tuesdays

Wednesdays

Thursdays

Fridays

Both the submission of this form,
and payment of the $50 registration fee,
are required to complete your registration.

You will be taken to the payment page
after submitting this information.