Fall Course Registration

Student Details

Student First Name *

Student Last Name *

Student Grade (Fall 2023) *

Student Date of Birth *

Parent Details

Parent 1name *

Parent 1 Phone *

Parent 1 Email *

Parent 2 name *

Parent 2 Phone *

Parent 2 Email *

Street Address *

City *

Region/State/Province *

Postal / ZIP Code *

Emergency Contact Name *

Emergency Contact Number *

Other Infromation

Child Shirt Size *

Class Placement *I am a new New East West Academy studentI am a current New East West Academy student

Does your child have any allergies? *YesNo

Please specify the allergies *

Terms & Conditions

Please review our Waiver for Liabilities, Conduct Policy and Registration and Tuition information included above before sign and submission*

I acknowledge New East West Academy's Waiver for Liabilities and Conduct Policy

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