Registration Form

Student Name *
Student Name
Address *
Cell Phone *
Cell Phone
Home Phone *
Home Phone
If you answered yes to any of the above questions, please note any modifications the student receives.
Parent Information *
Parent Information
Parent Cell Phone *
Parent Cell Phone
Parent Home Phone *
Parent Home Phone
First Course Credits
Second Course Credits
Third Course Credits
Fourth Course Credits
Fifth Course Credits
Type of Course
Semester for Enrollment *
Please indicate the semester in which you desire to enroll.
School approval is required for registration. In this box, please give the contact information for the person at your school who will grant approval of the course. This could be a school counselor or principal. Please include contact information such as an email or phone number.
Will this student be seeking NCAA eligibility?
Choose an option . . .

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Phone or Text