Course Registration Form

Student Registration Form

Fill out the form carefully for registration
Student Name*

English NameGiven NameFamily Name
Birth Date

MonthDayYear
Gender
E-mail*
example@example.com
Parent Name*

English NameGiven NameFamily Name
Course Options*
Course Packages*
Goals for your student
(i.e. Speaking in full sentences, Conversational English, Phonics)
My Products
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Free Class
1 Free Trial Demo Class $25.00 value

$ Free



1 Class
25 minute class session

$25.00



10 Class Package
10 Class Package. 25 minute sessions @ $20. 00 per session. $50.00 saving option!

$200.00



10 Class Group Package
10 classes at $18 per student per class. $180 per student! $80 in savings! (Separate registration required for each individual student.)

$180.00



Subtotal

$0.00

Tax

$0.00

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Student Registration Form