Kim's Virtual School Registration
Complete one per student
Email
*
example@example.com
Student Name
*
First Name
Last Name
Grade Level
*
Please Select
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
Preferred username
*
My Products
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Kim's Virtual School Tuition
$
100.00
for the
first month
then,
$
25.00
for each
month
Email
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: