Test - Lori English Online Registration

Registration

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WELCOME TO MY DATABASE REGISTRATION FORM. WE LOOK FORWARD TO WORKING WITH YOU.
Payment is required at time of enrollment to secure your spot. Please pay from your Parent Portal

* denotes required fields

Referral Information

How did you hear about us?

Referral Name

Main Contact

Family/Account Name Last Name

Where do you live?

Home Address

City

State/Prov

Postal Code

Primary Phone

Additional Info

Promo Code

Recital video Y/N

Contact #1

Parent or Legal Guardian First Name*

Last Name *

Type

How Can We Contact You?

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

Contact #2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Student #1

Student's First Name*

Last Name*

Level

Additional Info

Email

Grade Level

Transportation

Disabilities (Leave blank if NONE)

Special Notes

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunizations YN

Please select your classes carefully.
Payment will be required to complete enrollment and can be made via your Parent Portal account. If not paid your spot will not be held.
No exceptions.

Enroll in Classes

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

Select Class
Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Level

Additional Info

Email

Grade Level

Transportation

Disabilities (Leave blank if NONE)

Special Notes

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunizations YN

Please select your classes carefully.
Payment will be required to complete enrollment and can be made via your Parent Portal account. If not paid your spot will not be held.
No exceptions.

Enroll in Classes

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

Select Class
Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Level

Additional Info

Email

Grade Level

Transportation

Disabilities (Leave blank if NONE)

Special Notes

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunizations YN

Please select your classes carefully.
Payment will be required to complete enrollment and can be made via your Parent Portal account. If not paid your spot will not be held.
No exceptions.

Enroll in Classes

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

Select Class
Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Level

Additional Info

Email

Grade Level

Transportation

Disabilities (Leave blank if NONE)

Special Notes

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunizations YN

Please select your classes carefully.
Payment will be required to complete enrollment and can be made via your Parent Portal account. If not paid your spot will not be held.
No exceptions.

Enroll in Classes

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

Select Class
Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Level

Additional Info

Email

Grade Level

Transportation

Disabilities (Leave blank if NONE)

Special Notes

Allergies (Leave blank if NONE)

Medications (Leave blank if NONE)

Primary Doctor

Immunizations YN

Please select your classes carefully.
Payment will be required to complete enrollment and can be made via your Parent Portal account. If not paid your spot will not be held.
No exceptions.

Enroll in Classes

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

I would like to Trial this class

Select Class
Maximum number of enrollments reached.
Please use the parent portal to enroll in an unlimited number of classes.

Add Another Student

Required Policies

(Show-Hide Details)

I Agree to All of the Above

Enter your Full Name* April 26, 2024

Questions or Concerns

Comments

Payment Information

Account Information

Payment Plan

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

Country

City

State/Prov

Postal Code

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank Transit # (5-digits)

Institution ID (3-digits)

Account Number

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Registration

Referral Information

Main Contact

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Credit Card

eCheck/Bank Draft

Required Policies

(Show-Hide Details)