Regina Magic Academy Registration Form

Child's Name

Child's Age

Parent/Guardian Name

Parent's Phone Number

Parent's Email

Preferred Class

Emergency Contact Name

Emergency Contact Phone

Allergies/Medical Concerns

Payment Method

Parent/Guardian Consent:  I give permission for my child to participate in the Regina Magic Academy’s 8-week magic class. I understand that photos/videos may be taken during classes for promotional purposes and consent to their use.

Date