Strenght in Numbers - Student Registration

Strenght in Numbers - Student Registration

Student Registration
Child 1 Name

First NameLast Name
Child 1 Age
Child 1 Grade
Child 2 Name (If applicable)

First NameLast Name
Child 2 Age (If applicable)
Child 2 Grade (If applicable)
Parent/Guardian 1

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
example@example.com
Parent/Guardian 2

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
example@example.com
Emergency Contact

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
ACKNOWLEDGEMENT

I hereby acknowledge that I understand and agree with the following terms:
- Full payment is due at time of registration.
- This registration is non-refundable.
- I must pay in full for all 8 sessons at time of registration. There will not be refunds for sessions missed.
- A $15 fee will be charged for children picked up more than 10 minutes late.
- Strength in Numbers reserves the right to terminate participation without refund after 2 late pick ups of 15 minutes or more.
- Strength in Numbers reserves the right to terminate participation without refund if behavior is disruptive to the learning environment of others.
Signature

Payment will be collected via PayPal

8 Week Small Group Sessions. One session a week Weeks of 2/14 - 4/11

8 Week Small Group Sessions

One session a week Weeks of 2/14 - 4/11

$175.00 Quantity

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