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STUDENT ENROLLMENT

First and Last Name 

E-mail Address 

Age (if under 18 years old)      Grade Level (if under 18) 

Enrolling individually? (yes or no) 

If not enrolling individually, is this a family or group enrollment? 

Homeschooling? (yes or no) 

If not homeschooling, provide name of school or program you are currently enrolled in
(such as summer camp or organization):

School or Program City, State and Country:

Which course(s) are you enrolling for?

Why have you chosen this particular course(s)?

PARENT OR ADULT SUPERVISOR Name 

Fax Number 

Phone Number         

Best Time of Day to Call You 

Postal Mailing Address:


E-mail Address 

How did you hear about us?