Testing Registration Form

Parent's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PLEASE DOUBLE CHECK YOUR EMAIL ADDRESS

Your confirmation will be sent to this address from Kitty@SlusserLife.com
E-mail*
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
ALREADY REGISTERED & HERE TO PAY WITH PAYPAL?

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Child One

First NameLast Name
Child One Birthdate

MonthDayYear
C1 Testing at Grade Level
Child 1: Test - Site - Date
Child Two

First NameLast Name
Child Two Birthdate

MonthDayYear
C2 Testing at Grade Level
Child 2: Test - Site - Date
Child Three

First NameLast Name
Child Three Birthdate

MonthDayYear
C3 Testing at Grade Level
Child Four

First NameLast Name
Child Four Birthdate

MonthDayYear
C4 Testing Grade Level
Child 4: Test - Site - Date
Child Five

First NameLast Name
Child Five Birth Date

MonthDayYear
C5 Testing Grade Level
Child 5: Test - Site - Date
Child Six

First NameLast Name
Child Six Birth Date

MonthDayYear
C6 Testing Grade Level
Child 6: Test - Site - Date
Additional Comments:
Payment Method
REGISTERING NOW - PAYING LATER

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ITBS-Form E (Plus BJU Fee)$55.00
Test must be ordered from BJU Press Allow at least three weeks for delivery. BJU Fee is separate and paid by the parent.

Quantity

CAT-5 SURVEY (GRADES 1-12)$50.00
Group Testing

Quantity

Portfolio Review$50.00
In Person or Virtual

Quantity

PIAT$75.00
Must be in person.

Quantity

Total $0.00
Name

First NameLast Name
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