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Child (First Last) Mother (First Last) Father (First Last) CONTACT INFORMATION Street City State Zip , Phone(s) EMail(s) Emergency Contact Emergency Phone CHILD INFORMATION Gender Male Female Birth Date   Height   inches Weight     lbs Shoe Size Health Issues Comments Please tell us any concerns you have. We appreciate insight into strengths, weaknesses, idiosyncrasies of your child's character and physical well-being to help us guide effectively TUITION INFORMATION Cost Tuition for Clear Mind School is $120/semester or $200/year. Please make checks payable to AZC Clear Mind School If you cannot afford full tuition, please apply for assistance below. No child will be turned away because of inability to pay. Financial Assistance Submit Registration