Parent Name *

First Name

Last Name

Phone *

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Program Options *

Check one option per child

Monthly Pass – $60 per child (includes 4 Friday sessions)

Drop-In Pass – $20 per session

Media Release Waiver *

Iron Village Preparatory Academy may take photos or videos of program activities for use in promotional materials and documentation.

I give permission for my child(ren) to be photographed or recorded

I do not give permission for my child(ren) to be photographed or recorded