Leap 4 Fun LLC Online Registration

Registration

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Welcome to Leap4Fun online Registration. Please complete the information below and 'click' the submit button when done. Tuition is NOT charged to your credit card at this time. Our office will adjust your charge if the tuition needs to be prorated/adjusted for the current month.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Family Information

Family Last Name Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Contact #1

Best Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone *

Work #

Cell #

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School*

Grade Level

Special Needs

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School*

Grade Level

Special Needs

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School*

Grade Level

Special Needs

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School*

Grade Level

Special Needs

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

(format=mm/dd/yyyy)

Additional Info

School*

Grade Level

Special Needs

Enroll in Classes

Select Class *

Add Another Student

Required Policies and Agreements

Assumption of Risk

I understand that with any program such as this, some risks are involved, even through precautions are taken to prevent accidents. Therefore, I, my heirs, and child being registered hereby waive and release Leap4Fun, my child's instructor and school from all claims for damages and injuries.

I've read the above and agree.

Payment Policies

I understand the monthly tuition fee is due and payable before the 1st day of each month and no refunds will be given for absences on the part of the student. If you child is enrolled mid-month, your account will be prorated. No prorations or makeup classes will be given for school holidays that fall on lesson day. Tuition is based on four lessons per month (months with 5 lessons balance our for holidays). If I decide to withdraw my child, I will notify Leap4Fun in writing two weeks prior to the last class your child will be attending or you will be charged for the classes your child is registered for.

I've read the above and agree.

Aftercare Programs

I understand Leap4Fun is an outside contractor and their instructors have received a full background check. My child will be solely under the care of the Leap4Fun instructor, who is working for me, the parent/guardian, during my child's class.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments

Payment Information

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

City

State

Zip