Skip to content
Your cart is empty
Continue shopping
Have an account?
Log in
to check out faster.
Your cart
Loading...
Home
Tweens
Teens
Young Adults
Books
About Stacie
Register
Contact
Information
Information
Terms and Conditions
Code of Ethics
Privacy Policy
Disclaimer
Shop
Log in
Search
SMC Education Services LLC
Home
Tweens
Teens
Young Adults
Books
About Stacie
Register
Contact
Information
Terms and Conditions
Code of Ethics
Privacy Policy
Disclaimer
Shop
Search
Log in
Cart
Register
Program Registration
Please complete this form to register your child for our programs, classes, or workshops.
Parent/Guardian Information
First Name
*
Last Name
*
Email
*
Phone Number
*
Participant Information
First Name
*
Last Name
*
Date of Birth
*
Age Group
*
Select grade group
Tween (Middle School)
Teen (High School)
Young Adult (18-25 years)
Current Grade/School Year
Program Selection
Program Type
*
Select program type
Class
Workshop
Program
Camp
Program Name
*
Session Date
Session Time
Select time
Morning
Afternoon
Evening
Not Applicable
Emergency Contact
Emergency Contact Name
*
Emergency Contact Phone
*
Relationship to Participant
Additional Information
Medical Conditions or Allergies
Additional Notes or Questions
How did you hear about us?
Social Media
Friend or Family
Search Engine
Other
I give permission for my child to be photographed during program activities for promotional purposes
I agree to the terms and conditions and waiver of liability
*
Submit Registration
Choosing a selection results in a full page refresh.
Opens in a new window.