New School Interest Form

New School Interest Form
Name of School
Name of Representative *

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Number of Potential Riders
Desired Start Date (Term, year)
Please note that the cost of attendance is $500/term PER GROUP. We can support up to four riders per group, depending on the assistance required of each rider. Regardless of how many riders are in the school group, the same school group fee applies. Payment is due promptly at the end of term.
Should be Empty: