Service & Payment Plan*

Rock Academy: Session A

Price

$200.00

Guardian First Name*

Guardian Last Name*

Guardian Email*

Guardian Phone Number*

Student First Name

Student Last Name

Student Date of Birth*

Student Email (Optional)

Student Phone Number (Optional)

Student Address*

School for 2026-2027

Grade for 2026-2027

Allergies/Medical Conditions*

Other pertinent info

Emergency Contact Name & Phone Number(s) (in the event guardian cannot be reached)*

We can enroll this student in additional classes for you! Please list any other classes you would like to register them for for the 2026-2027 school year:

By checking the below box, I state that I have read, understood, and agree to the linked Terms & Policies.*

Payment Information*

Payment amount:

$200.00

Total to pay:

$200.00