The Learnatory Registration Form

Personal Information

Student Name*

Date of Birth*

School Name of Last School Attended*

Grade Level or Highest Level Completed*

Parent/Guardian Name (for youth and teens only)*

Adult: Occupation and Place of Employment*

OccupationPlace of Employment or School

Phone Number*

Please enter a valid phone number.

Email Address*

Please select the three areas where your child or you EXCEL:*

Please select the three areas where your child or you COULD USE SUPPORT:*

Learning Style & Interactions

Do you (teens) or does your child (parents) face any learning challenges or require special accommodations?*

Please describe any challenges (e.g., dyslexia, ADHD, etc.) and the support received:*

How would you describe your or your child’s interactions with peers and teachers?*

Mention any strengths or areas for growth desired in communication and social skills:*

Goals & Aspirations

What would you, or your child, like to learn, achieve, or improve through this program?*

Leadership Experience

List any extracurricular, community, or volunteer activities and positions held:

Level - Select One*

Youth 8 yrs - 12 yrsTeens 13 yrs - 17 yrs

My Products

Assessment (Required for All Programs and Services)The Assessment is $1.00 through November 8, 2024. Regular price is $59.

$1.00 Quantity
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MindSpire LaunchpadOne-day introductory workshop to the MindSpire Program: YOUTH: Wednesday, November 20, 2024, 6:15 pm , 2024 TEENS: Thursday, November 21, 2024. FREE with discount coupon. Use Coupon Code LAUNCH2024.

$49.00 Quantity
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MindSpire Program Single Pay Option Product Image

MindSpire Program Single Pay OptionUnlock potential, empower wealth-building, inspire success. MindSpire meets for meets weekly Saturdays, Jauary 11 - May 10, 2025 (16 meetings) with PrepPac and Certificate of Achievement. Payment of $496 by 12/31/24.

$496.00 Quantity
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MindSpire Program Two-Pay Option Product Image

MindSpire Program Two-Pay OptionUnlock potential, empower wealth-building, inspire success. MindSpire meets for meets weekly Saturdays, Jauary 11 - May 10, 2025 (16 meetings) with PrepPac and Certificate of Achievement. Payments of $280 by 11/30/24 and 12/31/25.

$280.00 Quantity
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MindSpire Program Three-Pay Option Product Image

MindSpire Program Three-Pay OptionUnlock potential, empower wealth-building, inspire success. MindSpire meets for meets weekly Saturdays, Jauary 11 - May 10, 2025 (16 meetings) with PrepPac and Certificate of Achievement. Payments of $208 by 11/30/24, 12/31/24, and 1/7/25.

$208.00 Quantity
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Life and Success Coaching (Private) - Youth Product Image

Life and Success Coaching (Private) - Youth8 yrs - 12 yrs. Dates open December 7, 2024. (Minimum 4 sessions/Price per Session)

$125.00 Quantity
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Life and Success Coaching (Private) - Teens Product Image

Life and Success Coaching (Private) - Teens13 yrs - 17 yrs Dates open December 7, 2024. (Minimum 4 sessions/Price per Session)

$125.00 Quantity
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Processing FeeThere is a 3% processing fee.

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Registration Form

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