Session Details
In-person Sessions $85/monthly - Virtual Sessions $65/Monthly - Homeschoolers $50/Monthly. Need to suggest a day & time? Please email us at info@bizkidz.us.
Please select your preferred session:
*
In-Person- Tuesdays 4:00 pm - 5:00 pm
In-Person- Wednesdays 4:00pm - 5:00 pm
Virtually- Fridays 5:00 pm - 6:00 pm
Virtually- Wednesdays 10:00 am - 11:00 am
Parent/Guardian Information
Full Name:
*
First Name
Last Name
Phone Number:
*
Please enter a valid phone number.
Email:
*
example@example.com
Home Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Prefered Method of Contact?
*
Email
Text/Call
Mail
Relationship to Biz Kid?
*
Biz Kid Information
Full Name:
First Name
Last Name
Date of Birth:
*
-
Month
-
Day
Year
Please Select Your Method of Schooling:
*
Traditional
Homeschool
Name of School/Co-op & Grade level:
*
Emergency Contact
Full Name:
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Relationship to Biz Kid?
*
Medical Information
Allergies? If so, please list them:
*
Existing Medical Conditions (If Applicable)
*
Medications currently taking? (If Applicable)
*
Physician's Name & Contact Information:
*
Pick Up Authorization
If there is anyone besides the Parent/Guardian listed in this form that will be picking up the Biz Kid named on this form, please list them here. No Biz Kid will be released to anyone that is not on this form!
Full Name:
First Name
Last Name
Phone Number
Please enter a valid phone number.
Full Name:
First Name
Last Name
Phone Number
Please enter a valid phone number.
Payment
Please make sure your selection match above:
*
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( X )
In-Person
$
125.00
for each
month
Virtual
$
95.00
for each
month
Homeschool
$
80.00
for each
month
Email
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Referral Information
How Did You Hear About Us?
Submit
Should be Empty: