ENROLLMENT REQUEST Tell us who is coming and which days.

// ENROLLMENT REQUEST

Tell us who is coming
and which days.

Fill this out and we will set the whole thing up for you: the account, the membership, the coupon code, and the afternoons on the calendar. You will hear back from a person, usually the same day. If you would rather do it yourself, the three steps above still stand.

Parent or guardian name *

Phone *

Email *

Confirmations and your coupon code go here.

Student name *

Student age *

Afterschool is ages 6–18. Over 18 signs up on a Create membership instead.

School

Needed if you want us to check bus routing.

Which afternoons do you want? *

Days are not locked in. You can change them week to week, and if the afternoon you want is not on the calendar, tell us and we will open it when we can.

Which path?

Preferred start date

Getting here

How did you hear about us?

Anything we should know?

I would like information about a scholarship seat. No tax returns or pay stubs required.

It is fine to contact me by phone, text or email about enrolling. *

Would rather talk to someone? Call 336-502-9604 or email arcade01@lazrdojo.com.

We use what you send here to enroll your student and nothing else. We do not sell or share it. LAZRdojo · 280 Charlois Blvd, Suite 202, Winston-Salem, NC 27103 · 336-502-9604

Tell us who is comingand which days.

LAZRdojo.com

Tell us who is coming
and which days.