Fun Wise® Math Enrichment Program
Please submit separate forms for each child
Amy Gail Buchman Preschool TUESDAY 3:15-4:00pm Class
All students that end school at 3 pm must take this class. Extended Day students are recommended to register for the 4:15 pm class.
Student Name
*
First Name
Last Name
Student Age
*
Student Gender
*
Female
Male
Student Birthdate
-
Month
-
Day
Year
Date
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Additional Contact Person
First Name
Last Name
Additional Contact Person Email
example@example.com
Additional Contact Person Mobile Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Referred By
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Fun Wise® Math Tuition + Registration
Registration + First Month Tuition; Monthly recurring tuition $60 charged automatically through May
$
60.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
By enrolling your child in the Fun Wise® Math program, you agree to the complete policy, Liability Waiver and Media & Marketing Release for participation in the Fun Wise® Math program.
View the complete policy at the link, https://funwise.com/fun-wise-math-waiver-and-release/
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