REGISTRATION

New Students registration

* Indicates required field

Last Name *

First Name *

Age *

Date Of Birth *

Cell/Home Phone Numbers (Contacts) *

Home Address *

E-mail (parent) *

School Name, Grade, Teacher's Name *

Mother's name *

Father's Name *

Emergency Contact (Name/Phone Number) *

Allergies/Special Needs *

PROGRAM *

Start Date (if known) *

Payment option *

e-transfer (to ekaterina@filmberries.com) Cheque (payable to Ekaterina Ionova) cash Tryout (Free) class

I agree to receiving marketing and promotional materials

Submit