Homeschool Academic Support - Accelerate Education
Mon - Thurs 2:30 - 4:30 PM
Start Date
*
-
Month
-
Day
Year
Your start day will be moved to the following day if the registrtaion is recieved after 3 PM
Student Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
School Grade
*
Please Select
2
3
4
5
6
7
8
9
10
Student Email
*
example@example.com
Student Phone Number
*
Please enter a valid phone number.
School Name
Mother Name
*
First Name
Last Name
Mother Email
*
example@example.com
Mother Phone Number
*
Please enter a valid phone number.
Father Name
*
First Name
Last Name
Father Email
*
example@example.com
Father Phone Number
*
Please enter a valid phone number.
Additional Comments/Notes
*
Payment
First payment includes a non-refundable $25 Semester Registration Fee
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Homeschool Academic Support - Accelerate Education
$
394.00
for the
first month
then,
$
269.00
for each
month
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Enrollment Agreement
By signing below, i agree to the above enrollment agreement.
*
Date of signature
*
-
Month
-
Day
Year
Date
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