Registration

Student Registration

Use the form below to register one student at a time. Students will be accepted on a first come, first serve basis. Students on an A/B Hybrid schedule will be given registration priority. Students that register but fall outside of these parameters will be placed on a waiting list, and you will be notified when seats open up. To ensure proper social distancing, we are limiting 20 students in the learning center on any given day.

* Indicates required field

Parent/Guardian Name *

First

Last

Parent/Guardian Email *

Phone Number (mobile) *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Student's Name *

First

Last

Student's Age *

Student's Grade *

School Name *

Academic Plan *

If A/B Hybrid, what are your remote days? *

Special Needs? *

If yes for special needs, please provide details *

Drop-off Time *

Pick-up Time *

Questions or Concerns *

Submit