Course Registration Form

Registration Form

Fill out the form carefully for registration
Parent Name

PrefixFirst NameLast Name
Phone Number
E-mail
example@example.com
Church Attended
Student Information
Student Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Courses
There are 3 main learning styles. There may be combinations of each of these but 1 will stand out more than the others. Please pick the 2 most relative.
Learning Style
What type of learner best describes your child?

Visual (Learns by watching or reading)Audible (Learns by listening or verbal instruction)Tactile (Learns by touch or hands on)
Additional Comments
Should be Empty:

Registration Form