Student Information

First Name *

Last Name *

We are accepting ages 5 to 21.5 (21 and a half)

Kindergarteners must turn 5 on or Before September 1st, 2023.

If the birth date is on or before September 1st, 2001, then they have aged out and not qualified.

Date of birth (mm/dd/yyyy) *

Gender *

Male

Female

Grade Level *

0
1
2
3
4
5
6
7
8
9
10
11
12
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Student Phone *

Student Email *

Student Race *

White
Asian
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Black or African American
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Address

Street *

City *

State of Michigan (Only) *

MI
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Zip Code (5 digits only) *

Only available to residents of Michigan.

Primary Parent/Guardian Information (With Whom the Student Resides)

Guardian First Name *

Guardian Last Name *

Guardian Email Address *

Guardian Phone Number *

Relationship *

Father, foster
Father, natural/adoptive
Father, step
Friend
Grandfather
Grandmother
Husband
Mother, foster
Mother, natural/adoptive
Mother, step
Nephew
Niece
Other
Significant other
Relative
Guardian
Legal Guardian
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Consent *

By checking the box and clicking SUBMIT below, you agree that we may call and/or text you at the number you entered above with reminders, offers and other info, including possibly using automated technology, text and recorded messages. Consent is not a condition of purchase. Reply STOP to opt out of text messaging. Standard rates apply.

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Questions? Give Us A Call

(800) 297-2119