Registration

Please complete the registration form below.

Student Name*
First Last
Student Age*
Student Date of Birth*
Parent/Guardian Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Home Phone*
Cell Phone
Email*
I give permission to photograph my daughter during class/events for TYLOG website/Facebook page and by our photographer in her portfolio.*
- Yes
- No
I agree to TYLOG Policy*
- Yes
Signature*
- By checking this box, you (the parent/guardian) are signing this document.
Please review all information to ensure it is correct before you submit your registration. Thank you!
Comments
This field is for validation purposes and should be left unchanged.

Address

The Young Ladies of Grace
Georgetown Square
5225 Sheridan Drive,
Williamsville NY