Apprenticeship Program Registration Form

Apprenticeship Program Registration
Child Information
Child's Name

First NameLast Name
Birth Date

MonthDayYear
Grade (as of next school year)
Gender

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Name

First NameLast Name
Home Number

Area CodePhone Number
Cell Number

Area CodePhone Number
E-mail
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Type a question
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Youngprenuers during the selected session.

Details and Information

If there are any further questions, contact Shabobby Williams at (561) 720-9415 or Shabobby@icloud.com
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

My Products

One-Time Fee$100.00

Quantity

Deposit $50.00

Quantity

Total $0.00

Credit Card

Apple Pay

Google Pay