If you are interested in enrolling your child into one of Misty Forest's programs please fill out this form and someone will contact you to complete your enrollment.

Student Information
Students First Name Last Name Middle Name
Students Primary Address
Students Primary Email Address
Birthday Month Day Year
Age Gender  
 
     
_________________________________________________________

Parent Information
Parent First Name Last Name  
 
Parent Primary Contact #
Parent Primary Address
Parent Primary Email Address
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Parent First Name Last Name  
 
Parent Primary Contact #
Parent Primary Address
Parent Primary Email Address
 
_____________________________________________

Additional Emergency Contact Information
Additional Contact #
Name:
Additional Adults Permitted to Pick Up Student
Additional Adults Permitted to Pick Up Student

Please provide us with a code word that we can keep on file as an additional safety measure. This provides an extra level of security in case of an emergency and a separate contact is picking up your child.

Code word

Please keep the code word for your records!

Physician Information
Student's Primary Physician
Primary Physicians #

Medical Information
Please list the current health of the student including physical, mental and emotional conditions. Also list allergies and include any prescribed medications.
Special instructions in treating the student physically, mentally and emotionally.

General Information and Inquiry
Sibling's Name Sibling's Age Form in which Sibling is schooled School Name

What parts of the day is best for Misty Forest activities for your family?
Morning Mid-Morning Afternoon
Mid-Afternoon Early Evening Evening

What part of Misty Forest do you have interest in?
Courses for student Tutoring Test Prep Afterschool Enrichment
Clubs for Student Counseling Sleepovers Parenting Resources
Support Groups Events Parenting Workshops Adult Enrichment Classes
Family Events Community Groups Other Other

What other activities do you have interest in?
Volunteering Facilitating Outreach  

What path brought you to Misty Forest?

Path
Please Specify
Search Engine
Radio Ad
Print Ad
Word of Mouth
Another Business
Event/Fair

Permissions

I give permission to use video/photographs of the said for Misty Forest publications.
I agree
I agree only if I am able to view said photograph or video
I disagree

I give permission to publish contact information in our contact directory.
I agree
I disagree

I give permission for faculty and students to use the students contact information for course and club communication.
I agree
I disagree

A one time Misty Membership Fee is due at registration
I agree and will pay at registration
I have already paid the enrollment fee