Registration Form - Beechwood ACT Prep, Inc.
After submitting this electronic form, please check your email for the mailing address (6254 Streamside Drive, Independence, KY 41051). If you don't see an email from Google Forms or an email from, check your "Junk" or "Clutter" folders, especially if there are restrictions on your email server.

Once you submit your registration form and receive confirmation of your registration, you can mail your payment to our business mailing address (6254 Streamside Drive, Independence, KY 41051) or you can Venmo us your payment using the @Julie-Rash-1 Venmo profile.

You will receive a Payment Confirmation email from with all of the pertinent class information AFTER your payment is received.  
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Email *
Please fill-out this registration form to let us know that you want to come to our class. However, your spot in the class is only secured with your payment. If we do not receive payment, we will contact you the week before the class starts to remind you to secure your spot with payment. We have a variety of accepted payment methods: check, money order, cash, and payment plans. Please read the email that you will receive upon completion of this form.
Please choose the SESSION that you would like receive 24 hours of ACT Prep - All Four Subjects *
Which scenario best describes your registration? *
What is the student's last name? *
What is the student's first name? *
What high school does the student attend? *
What is the student's graduation year? *
Parent/Guardian Email Address *
Student Email Address *
Parent/Guardian Phone Number                   Please enter using this format: (555) 555-5555 *
Student Phone Number                                Please enter using this format: (555) 555-5555
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