Registration

Please fill out the form below.
You may also download forms for our specialty programs and mail them in by clicking the program name below:

 

Name of Program*:

Location (if applicable):

1st Child

Name*:

Age*:

School*:


2nd Child

Name:

Age:

School:


Parents

Names*:

Address*:

City*:


Phones & Email

Home*:

Cell*:

Emergency*:

Email*:


Please provide the dates and start/pickup times for the days your child(ren) will attend:

Start Date*:

End Date:

Mondays

 Yes No       Start: Pickup:

Tuesdays

 Yes No       Start: Pickup:

Wednesdays

 Yes No       Start: Pickup:

Thursdays

 Yes No       Start: Pickup:

Fridays

 Yes No       Start: Pickup:

Saturdays

 Yes No       Start: Pickup:

Sundays

 Yes No       Start: Pickup:


My child(ren) will be picked up by:

Name*:

Phone*:

Name:

Phone:


Do you have any other comments or feedback? Does your child have any food allergies/restrictions? Are there any specific academic or social values that you hope we focus on for your child in this program?




Please check:
Pay by credit card (Visa, MC) 
   Call 760-436-1514

Pay by check 
    mail to: We Are Coaches, 1341 Calle Scott, Encinitas, CA 92024

Paypal 
    (After this form is submitted, please go to our "Donate" page and hit the
    PayPal button to make a payment.)

Please read and acknowledge the following by checking the checkbox.
The form will not submit without this acknowledgement.

 I hereby give permission to my son/daughter to participate in the We Are Coaches Program. I release and hold harmless We Are Coaches, Inc., its officers, director, agents, and sponsors (hereafter referred to as “Released Parties”) from any and all liability for injury to my person or property caused in any manner, including the negligence of the Released Parties, by my and my child’s participation in the Art & Fun hereby give permission for emergency first aid by enrichment personnel or a licensed medical doctor if necessary.

 I understand that for a payment refund, I must cancel within 24 hours.

IMPORTANT NOTE:
Parents are responsible for prompt pick-up of your child. A $10 fee will be applied for late pick-up.

(After submission we will call or email to confirm your registration.)