Harmony Education Foundation Online Registration

Registration

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We're excited to welcome your child/ren to our program!

All information provided must be accurate and current. Please be aware that registration must be completed 48-72 hours before your child/ren's start date. Should you have any inquiries or require additional assistance, please don't hesitate to reach out to our Support Team at support@elitelearning.org or (281) 888-5233.

* denotes required fields

Referral Information

How did you hear about us?

Family Information

Parent/Guardians Last Name*

Where do you live?

Home Address*

City*

State*

Zip Code*

Primary Phone*

Additional Info

Emergency Contact: In case parent cannot be reached ( Full Name, Phone Number, Relation to Child)*

Health Insurance Provider*

Military Personnel? (Y/N)*

School Staff? (Y/N) *

Free/Reduced Lunch?(Y/N)*

Media Release Permission(Y/N)*

Contact #1

Primary Parent/Guardian First Name*

Last Name *

Relation to child*

How Can We Contact You?

Home Phone

Work # *

Cell # * Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Secondary Parent/Guardian First Name*

Last Name*

Relation to child*

How can we contact you?

Home Phone

Work # *

Cell # * Receive Text Message Notifications

Email* (Emails are kept confidential)

Confirm Email*

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Special Needs, if any please specify, N/A if none*

Allergies if any please specify, N/A if none*

Medication if any please specify, N/A if none*

Students Physicians- Name, Number, Address*

Student(s) Start Date *

Student(s) Ethnicity?

Authorized Person for Pickup*

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Special Needs, if any please specify, N/A if none*

Allergies if any please specify, N/A if none*

Medication if any please specify, N/A if none*

Students Physicians- Name, Number, Address*

Student(s) Start Date *

Student(s) Ethnicity?

Authorized Person for Pickup*

Enroll in Classes

Select Class *

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Special Needs, if any please specify, N/A if none*

Allergies if any please specify, N/A if none*

Medication if any please specify, N/A if none*

Students Physicians- Name, Number, Address*

Student(s) Start Date *

Student(s) Ethnicity?

Authorized Person for Pickup*

Enroll in Classes

Select Class *

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Special Needs, if any please specify, N/A if none*

Allergies if any please specify, N/A if none*

Medication if any please specify, N/A if none*

Students Physicians- Name, Number, Address*

Student(s) Start Date *

Student(s) Ethnicity?

Authorized Person for Pickup*

Enroll in Classes

Select Class *

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level*

Special Needs, if any please specify, N/A if none*

Allergies if any please specify, N/A if none*

Medication if any please specify, N/A if none*

Students Physicians- Name, Number, Address*

Student(s) Start Date *

Student(s) Ethnicity?

Authorized Person for Pickup*

Enroll in Classes

Select Class *

Add Another Student

Required Policies and Agreements

(Show-Hide Details)

Liability Waiver

I've read the above and agree.

Parent Handbook

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name* October 5, 2024

Questions or Concerns

Comments

Payment Information

Account Information

ePayment Schedule*

Membership Type*

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 Code

Registration

Referral Information

Family Information

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 and Agreements (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Account Information

Credit Card

Required Policies and Agreements

(Show-Hide Details)