Buhler Christian Academy Registration Form

Child Information*

Phone Number*

Format: (000) 000-0000.

E-mail*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian #1*

First NameLast Name

Parent/Guardian #2

First NameLast Name

If you will be paying your Registration Fee via Cash it must be paid in full by August 5th. Thanks.

Enrollment Options

Prekindergarten (Must be 4 by September 1st)

$85.00 Quantity

Kindergarten (Must be 5 by September 1st)

$250.00 Quantity

1st through 6th

$360.00 Quantity

3's Class

$85.00 Quantity

Waitlist

Click this box If the class you are interested in is full. Select the class you are interested and fill out the rest of the form as usual. Thank you so much for your interest!

$ Free

Waitlist	Quantity
3's Class
Prekindergarten
Kindergarten
1'st through 6th

Enter coupon

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Payment Methods

Credit Card

ACH Bank Transfer