Class Information

Program: Magic

Course: Classic

Dates:
Oct 20,27
Nov 03,10,17
Dec 01
Class schedule:
Tuesday 4:00 PM - 5:00 PM (K -5th)
Cost: $250

School Information

School: Phoenix Modern

Address: 200 E. Mitchell Dr., Phoenix, AZ
Phone: (480) 779-3117

Student Information

First Name *

Last Name*

Grade *

Gender *

Classroom # and/or teacher name

Is your child enrolled in aftercare?*
Yes No

Specify any special needs if applicable

Parent Information

First Name*

Last Name*

Address 1*

Address 2

City*

State/Province*

Zip/Postal Code*

Phone Number*

Email Address*

Other Authorized Guardian

First Name

Last Name

Relationship

Phone

Emergency Contact

Same as parent information

First Name*

Last Name*

Phone*

Payment Information

Same as parent information

First Name*

Last Name*

Address 1*

Address 2

City*

State/Province*

Zip/Postal Code*

Card Information

Card Number*

Expiration Date*

CCV*

Important Stuff

I have read and agree to the Policies.
I have read and agree to the Waiver and Release.

Please do not close your browser or click the back button.

Registering more than one child? To avoid an error message, please either use a different credit card for the second transaction or wait one day to use the same credit card. Our system uses a safety precaution to avoid duplicate charges.