Enrollment Form

Please Complete Form to Enroll Your Child.

* Indicates required field

Child's Name (Include Preferred Name) *

First

Last

Child's Date of Birth, Age, and Grade *

Child's School *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Guardian Name *

Phone Number *

Alternate Phone: *

Student Pick-Up Information/ Emergency Contact- *

Student Pick-Up Information/Emergency Contact-2 *

Injury or Medical Emergency- Hospital Choice, Doctor's Name and Phone *

Child's Medical History or Concerns, Include Allergies and Medications *

Photography Permission- Please initial in the box: I give my consent to Lowcountry Gifted Minds, LLC to photograph or video my child and to use pictures and/or stories in connection with any of their work without compensation. *

Fees:
All fees must be made at time of Registration.

Discipline: Children are expected to respect the teachers and each other. All teachers are experienced with working with children and create a positive approach to discipline. If we are unable to resolve on-going or serious behavior issues that interfere with the learning of others, the child will be dismissed from the program. A refund will be given for classes not attended. *

Permission- Please sign permission for your child's participation and fitness to participate in classes by printing your name in the box below. I certify that to the best of my knowledge that my child is in good mental and physical health and can participate in the Lowcountry Gifted Minds classes. *

I agree to receiving marketing and promotional materials

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Enrollment Form

Please Complete Form to Enroll Your Child.

A FUN Learning Adventure!

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