Enrollment AgreementPlease enable JavaScript in your browser to complete this form.Student InformationFull Name *FirstMiddleLastGender *MaleFemaleDate of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address *Address Line 1Address Line 2CityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent or Guardian InformationParent 1 *Parent 1Parent 2 *Parent 2ContactHome *HomeMobileMobileWorkWorkEmail Address *Email AddressEmergency ContactEmergency Contact *Emergency ContactEmergency Contact RelationshipRelationshipEmergency Contact Number(s)Emergency Contact Number(s)Program, Tuition, & Payment InformationParent / Guardian InitialsClear SignatureMMA School Director Initials Program *Toddler MorningToddler ExtendedToddler Full DayPrimary MorningPrimary ExtendedPrimary Full DayPayment Plan1 Payment2 Payments9 PaymentsThe *Non-Refundable Mandatory Ten Percent (10%) Deposit must be paid upon the signing of this enrollment agreement, confirming the student’s enrollment for the School Year 2021-2022.Parent / Guardian InitialsClear SignatureMMA School Director Initials Consent for Use of Photograph as Promotional MaterialDo you consent to the use of your child’s photograph or video for MMA’s website, Facebook Page, and other promotional or marketing materials? (None of the children’s names will be posted or printed with the photographs or videos.)We consentWe DO NOT consentAgreementThe *Non-Refundable Mandatory Ten Percent (10%) Deposit must be paid upon the signing of this enrollment agreement, confirming the student’s enrollment for the School Year 2021-2022.All the information that I have provided in this application form are true, accurate, and to the best of my knowledge:Printed Name of Parent or GuardianSignature of Parent or Guardian *Clear SignatureYou may use a mouse or your finger to sign.Date of SigningMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Submit Application
