After school and weekend classes Registration
Student Information
Medical Information
Classes Interested (Select Preferred Class level / timing)
Languages
Instrument
Vocal Lessons
Dance Lessons
Academics
Arts & Crafts
Yoga
Culture
Student 2 Information
Medical Information
Classes Interested
Languages
Instrument
Vocal Lessons
Dance Lessons
Academics
Arts & Crafts
Yoga
Culture
Student 3 Information
Medical Information
Classes Interested
Languages
Instrument
Vocal Lessons
Dance Lessons
Academics
Arts & Crafts
Yoga
Culture
Parent Information (is required for students under 18)
Local Emergency Contact
Fees and Payment
How would you like to pay ?
Above information is correct to my knowledge.
I authorize Samspra Academy to render services / seek medical help to the student. I understand that I am financially responsible for any expenses.
Parent's / Guardian's signature :