Reading Skills Class Registration
Don't let their minds fall behind.
1. Parent's First Name
3. Parent's Last Name
*
4. Parent's Phone Number
*
5. Parent's Email Address
*
example@example.com
7. Street Address
*
8. City
*
Country
*
9. State or Region
*
10. Postal Code
*
11. Student's First Name
*
12. Student's Last Name
13. Age
*
16. Current Grade Level
*
17. Current School
*
Second Student (if applicable)
First Name
Last Name
Grade Level
Age
School
Registration Payment (You can choose pay later when you select PayPal.) Early bird pricing of $99 ends on April 30th.
*
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Registration
For the Reading Skills Classes
$
199.00
Registration for second student
Second child is discounted to $50
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Submit
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