E.nopi Bridgewater Online Registration

Registration

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Thank you for your interest in the Eye Level Learning Centers of Bridgewater, Basking Ridge, Hillsborough and Warren! Please enter the following information so we can learn a little more about you.

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Parent/Guardian Information

Child's Last Name Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info

Contact #1

Parent/Guardian First Name*

Last Name *

Relationship*

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

Contact #2

Parent/Guardian First Name

Last Name

Relationship

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School

Grade Level

Allergies (Leave blank if NONE)

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School

Grade Level

Allergies (Leave blank if NONE)

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School

Grade Level

Allergies (Leave blank if NONE)

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School

Grade Level

Allergies (Leave blank if NONE)

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

T-Shirt Size

School

Grade Level

Allergies (Leave blank if NONE)

Add Another Student

Required Policies and Agreements

Policy

Welcome to Eye Level Customer Portal !!

Below are the basic center policies.

1. Payments are due by 1st of each month.
- Payments after the 15th will incur a $15 Late Fee.
- All bounced checks will incur a $20 Fee.

2. Payment with credit card can be done ONLY via Customer Portal (Auto Pay)
- You can update the credit card information after reviewing this policy.
- If you do not feel comfortable paying by credit card online, feel free to drop a check and cash payment at the center.

3. 1 make-up class per month with at least 24 hour notice via email/phone
- If you cannot make it to your scheduled time slot, you have 2 options.
- You can pick up the books whenever we are open or schedule a make-up.
- To schedule a make-up class, give us a call or send us an email at least 24 hours prior to the scheduled class.
- We plan all our classes ahead of time as it involves grading, lesson planning, staffing etc.
- We have little room to shift things around on a same day basis.
- Same day make-ups will not be permitted.

4. Changes to enrollment must be notified by 15th for following month (Vacation/Withdrawal/Change in Subject)
If you are going on vacation or withdrawing from classes or would like to change the subject, please let us know by the 15th of each month.
After the 15th, we will schedule all the payment batches, order all the books for next month and accordingly pay all our royalties.
For any official changes we will need you to fill out a paper form (Forms available at the center) by the 15th.
This will act as the official document for any changes.
Please understand that we will not accept any verbal change.

Thank you.

Luke

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

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