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Self Pay Course Choice Registration Request

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Student's First Name

Student's Last Name

Student's Email

Confirm Student's Email

Grade Level

School

School Phone (include area code):

Parent/Guardian/Responsible Party First Name

Parent/Guardian/Responsible PartyLast Name

Parent/Guardian/Responsible Party Address

Parent/Guardian/Responsible Party City

Parent/Guardian/Responsible Party State

Parent/Guardian/Responsible Party Zip

Parent/Guardian/Responsible Party Cell Phone Number

Parent/Guardian/Responsible Party Email

Confirm Parent/Guardian/Responsible Party Email

Parent/Guardian/Responsible Party Work Phone Number

Course

Semester Block

Submit the word you see below:


*** Course Choice Registration Deposit required to complete registration. Registrations submitted without required $50/class deposit will be discarded.

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