ELP Registration Form

Welcome to the Exceptional Learning Program at The Bentley Center

Winter 2024 Dates - Wed., January 17 through Wed., March 6, 2024
Registration Form

Thank you for registering for classes at The Bentley Center
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Grade Level and School Name 2023-24
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent E-mail
example@example.com
Mobile Number
Emergency Contact Phone Number
Courses
Robotics
Additional information about your child, including allergies, medical issues, or disabilities
Liability Release

We assume full responsibility for all risk of injury or loss that may result from participation in any current and future classes at The Bentley Center and agree to hold harmless, release, and forever discharge The Bentley Center, its contributors, and their respective officers, directors, agents, and employees. We agree to waive any and all claims and demands whatsoever which we, our child, or any third party may now or hereafter have against any party of The Bentley Center by reason of accident, illness, injury, or death to persons, or damage to, or loss of any property, arising or resulting directly or indirectly from our child’s participation in this Program. {studentName}We have read and understood the above statements, and we hereby agree to all of the foregoing terms and conditions.
Student Name
Parent/Guardian Signature
Student Code of Conduct

The Bentley Center expects students:

▪ to respect individuals of different races, cultures, religions, genders, disabilities, and national origins
▪ to behave in a friendly, cooperative, and responsible manner toward all persons in our classes
▪ to be responsible for one’s own actions
▪ to behave in an honest and trustworthy manner
▪ to adhere to all rules and directions given by staff

PROHIBITED ITEMS

The following is a list of items students are prohibited from bringing to the site:

▪ weapons of any kind or any toys that look like weapons
▪ any flame-producing device (including matches, lighters, and firecrackers)
▪ pets of any kind
▪ all electronic devices except those deemed necessary by instructors

DISMISSAL POLICY

We cannot accommodate students who are unable to live up to the expectations set forth in the Code of Conduct. Violation of any of the policies may result in immediate dismissal. No refunds will be made to students dismissed from The Bentley Center.

In addition, students may be dismissed from The Bentley Center for the following reasons:

▪ vandalism or theft
▪ engaging in disruptive behavior
▪ leaving the classroom unaccompanied by a staff member
▪ being in restricted areas unaccompanied by a staff member
▪ any violation of the safety or well-being of any person

We have read the Code of Conduct policies. We understand our responsibility to abide by the program requirements outlined above, and that failure to comply may result in suspension and/or expulsion from the program.
Student Name
Parent/Guardian Signature
Classes Offered in Winter 2024
prevnext( X )
Robotics 20 hours of Instruction
$600.00 Quantity



Robotics Trial Class (non-refundable)Please register here if you wish to try a class before signing up for the session. Your child's spot cannot be guaranteed until full tuition is paid.
$30.00 Quantity



Nature, Math, and Art Converge8 hours of Instruction
$260.00 Quantity



Nature, Math, and Art Converge Trial Class (non-refundable)Please register here if you wish to try a class before signing up for the session. Your child's spot cannot be guaranteed until full tuition is paid.
$20.00 Quantity



Kidpreneurship8 hours of Instruction
$260.00 Quantity



Kidpreneurship Trial Class (non-refundable)Please register here if you wish to try a class before signing up for the session. Your child's spot cannot be guaranteed until full tuition is paid.
$20.00 Quantity



Total

$0.00

Payment Methods

Debit or Credit Card

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

You may also pay by check, addressed to:

Gayle Bentley
23942 Ibis Court
Laguna Niguel, CA 92677
Should be Empty:

Welcome to the Exceptional Learning Program at The Bentley Center

Registration Form