Click here for re-enrollment. Enrollment Father's name Mother's name --- Mailing address Mailing city Mailing state Mailing zip --- Shipping address Shipping city Shipping state Shipping zip --- Home phone Work phone Parent's email Daytime phone Supervisor of student's school work if other than the student's parent (Please include supervisor's name, address and phone number) --- Student's full name Gender Birthdate --- Does student have learning difficulties? Describe. Last school attended Last grade completed and when? Current grade? --- School address School city School state School zip --- Phone Fax Contact person --- We would like to begin school starting --- I am responsible for the payment of all fees for this account. I understand the registration fee is non-refundable and is to be paid each school year beginning July 1st. My student will be supervised during study time by a parent or responsible adult who will not allow the student to copy answers from the score keys. I agree to follow the procedures typed in the Parent/Supervisor Training Booklet. I will keep all tests and test keys in a secure place inaccessible to the student. I will grade the tests and return them promptly at the end of each quarter. Signature of Parent/Guardian Date
