Kaufman Center


	USER REGISTRATION
	To create an account with the Kaufman Center, please complete the form below and press Submit. If you are a Parent or a Guardian please complete the form with your own information. During the Class registration process Student information will be entered. Fields in Bold are required. To ensure that your registration progresses smoothly, we encourage you to not use your browser's back button. You will have an opportunity to make corrections or additions in the confirmation page.


	User First Name:	User Last Name:


	Email (this will be your user id):


	Password:	Confirm password:


	Home Phone:	Work Phone:


	Cell Phone:	Fax


	Street Address:


	Apartment #:


	City:	State:


	Zip:


	Occupation:	Company:




	Will you be registering any students younger than 18 years?	Yes No

	Relationship to Student:




	Mac users, we recommend that you use Safari rather than Internet Explorer to access our registration system.