Step By Step Enrichment Center Student Pre-Registration Form

Step By Step Enrichment Center Student Pre-Registration Form

Fill out the form carefully for registration
Student Name

First NameMiddle NameLast Name
Home Address
Age
Date of Birth

MonthDayYear
Date
Phone Number

Area CodePhone Number
Mobile Number

Area CodePhone Number
Sex
Grade entering
Date
Parent/Guardian Name

First NameLast Name
Parent Signature
Additional Comments
Should be Empty: