Student Information

Student's Name

Student's Age

Cell Phone

Email

Parent Information (if applicable)

Parent Name

Cell Phone

Home Phone

Email

Class Information

Classes

Pickup Information (if applicable)

Pickup Person 1: Name

Pickup Person 1: Phone

Pickup Person 1: Relationship

Pickup Person 2: Name

Pickup Person 2: Phone

Pickup Person 2: Relationship

Medical Information

Emergency Contact

Student's Doctor Name

Student's Doctor Phone

Student's Medical Information (Allergies, Medication, etc)

Additional Comments or Message

Acknowledgment

The submission of your registration details above acknowledges that you (or your child) will adhere to Prodigy Talent Training's Policies and Procedures, which will be provided after your Registration is confirmed. Click the drop down below to acknowledge: