Youth Workshops Registration Form

All Anaheim Hills Buzz users get 20% OFF registrations.
Sign up a sibling and receive an additional 10% OFF for select workshops.

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ENROLL IN CLASSES

Choose your student's grade level.Classes for Grades 1-3Classes for Grades 4-6

Grades 1-6: Summer Camp, Jun 24-28 (Daily, 10am-1pm)

• 1 Student with 20% OFF Buzz Discount ($180)
• 2 Students with 20% OFF Buzz Discount ($360)
• Not selected

Please consider including a donation.

Total Amount

$0.00

Stripe Credit Card *

Card

Name on Card

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STUDENT INFORMATION

Name *

First

Last

Birthdate *

Gender *

Student Email *

Address *

Address Line 1

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

School Name *

Grade *123456789101112

How did you hear about our youth workshops? *

Are you registering a sibling?NoYes

Sibling: Name

First

Last

Sibling: Birth Date

Sibling: Gender

Sibling: Email

Sibling: Cell Phone

Sibling: School Name

Sibling: Grade123456789101112

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PARENT/GUARDIAN INFORMATION

Salutation *Mr.Ms.Mrs.Dr.

Name *

First

Last

Relationship *

Is your address different than the student's? *NoYes

Email *

Cell Phone *

Would you like to add a second Parent/Guardian? *NoYes

P/G #2: SalutationMr.Ms.Mrs.Dr.

P/G #2: Name

First

Last

P/G #2: Relationship

P/G #2: Is your address different than the student's?NoYes

P/G #2: Email

P/G #2: Cell Phone

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EMERGENCY CONTACT INFORMATION

Please list an emergency contact other than Parent/Guardian 1 or 2

Emergency Contact *

First

Last

Emergency Contact Cell Phone *

Emergency Contact Relationship *

MEDICAL INFORMATION

Describe Allergies/Medical Information *

Describe any sensitivities or learning needs *

Sibling: Describe Allergies/Medical Information

Sibling: Describe any sensitivities or learning needs

Comment or Message

Phone

Enroll Now!