Student Information
Name
First Name
Middle Name
Last Name
Birth Date
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Month
-
Day
Year
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Email Address
Phone Number
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Program Type
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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
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Address
Street Address
Street Address Line 2
City
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I would like to pay for the Following
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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:
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Core Academic Program
EC Program
Spell to Communicate Program
Homeschool Drop-In
My Products
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Regististration Fee
$
300.00
Quantity
1
2
3
4
5
6
7
8
9
10
Supply Fee
$
200.00
Quantity
1
2
3
4
5
6
7
8
9
10
Testing Fee
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card Details
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