Course Registration Form

Registration Form

Fill out the form carefully for registration
Parents Name*

First NameMiddle NameLast Name
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parents E-mail*
example@example.com
Mobile Number*
Start Date attending

MonthDayYear
Date
End date

MonthDayYear
Date
Check weeks signed up for*

July 3-7July 10-14July 17-21July 24-28July 31-august 4August 7-11August 14-18August 21-25August 28-sept 1
Emergency contact*
Allergies
Any allergies or concerns
sign this waiver and your all set!

My Products

1 week Discount code is Friend1week -20$

$350.00 Quantity
Item subtotal:$0.00

2 weeks2 weeks when signing up with a friend use coupon code Friend2weeks

$595.00 Quantity

3 weeks3 weeks When signing up with a friend coupon code is Friend3weeks

$875.00 Quantity
Item subtotal:$0.00

4 weeksUse coupon code 4weeks at checkout! On sale $995

$1,070.00 Quantity
Item subtotal:$0.00

Enter coupon

Total

$0.00

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