Student Information
Name
First Name
Middle Name
Last Name
Birth Date
-
Month
-
Day
Year
Date Picker Icon
Email Address
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Program Type
Please Select
Core Academic Program
EC Program
Spell to Communicate Program
Homeschool Drop-In Program
Parent Information
Parent/Guardian
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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I would like to pay for the Following
Select your program
Please Select
Core Academic Program
EC Program
Spell to Commincate RX Program
Homeschool Drop-In Porogram
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Registration fees, supply fees, and deposits are non-refundable.
I would like to Register for the following:
*
Please Select
Core Academic Program
EC Program
Spell to Communicate Program
Homeschool Drop-In
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Regististration Fee
$300.00
$
300.00
Quantity
1
2
3
4
5
6
7
8
9
10
Supply Fee
$200.00
$
200.00
Quantity
1
2
3
4
5
6
7
8
9
10
Testing Fee
$150.00
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
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