Want to Request Registration in a LifePlay Class?

Sign Up Your Child Today!!

To request registration in any LifePlay Productions class or event, please complete the short form:

( 1 ) Choose a School & Class...

( 2 ) Tell Us About Your Child...

First Name:		Last Name:
Child's Grade:		Gender:	M F
Birthdate:	\	Child's Email:
Any special conditions, behaviors, allergies, or recommendations regarding your child?

( 3 ) How To Contact You...

First Name:		Last Name:
Email:		Phone:
ZIP Code:
	Receive updates about LifePlay classes at my child's school.

( 4 ) [OPTIONAL!] Pay By Credit Card...

You have the OPTION to secure your child's registration with a credit card. (We also gladly accept check by mail.) This is NOT an Online Payment! Once we receive your request, we will contact you by phone or email to confirm your child's registration, and NOT charge your credit card until that time.
Type of Card:		Card Number:
Exp. Date:	\	Name on Card:
Billing Address:
City:		ZIP Code: