Course Registration Form

Student Course Registration Form

9123 Broadway Temple City, California 91780 Tel: (626) 282-9936 Fax: (626) 282-9937
Name of Student:*

First NameMiddle NameLast Name
Birth Date:*

MonthDayYear
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Email Address:*
Student Phone Number:*

Area CodePhone Number
Name of School:*
School Address:*
Student 2x2 Passport Photo (Please Wear White Shirt) *

Cancelof
Name of Parent #1 Name:*

First NameMiddle NameLast Name
Parent #1 Email Address:*
Parent #1 Phone Number:*

Area CodePhone Number
Name of Parent #2 Name:

First NameMiddle NameLast Name
Parent #2 Email Address:
Parent #2 Phone Number:

Area CodePhone Number
Types the Courses Interested*
Fees:

Students pay FPS:

**Application Fee: $75 (Non-refundable)

Application Fee may be paid using the link below:

https://www.fpsch.org/products/foothill-preparatory-school-summer-school-registration/
By clicking the button below, printing and signing my name below, I indicate that I understand and agree to non-refundable fees for the service. I agree that a legal Fax or email is equivalent to an original legal document that I signed and printed my name.*

I hereby acknowledge that I have read, understand and agree to the terms of this document relating to a non-refundable payment for the service. I have read and agree.
Student's Signature (Use your computer mouse to sign)*

Clear
Date*

MonthDayYear
Date
Parent's Signature (Use your computer mouse to sign)*

Clear
Date*

MonthDayYear
Date
Please verify that you are human*
Should be Empty:

Student Course Registration Form