Mindful High School 2.0 • Class Registration • SEPTEMBER 2020
Please fill out this form for pre-registration for Mindful High School 2.0 Online with Myra Smith.
You are eligible to take this course if you have completed the level 1 class.
This course is for high school students in grades 9 - 12.
Before completing this form, please make your tuition payment or scholarship request.
Tuition payments can be made via Venmo.com to @myrajeansmith or to Paypal.com to the address
The link for scholarship requests is on the
Mindful HIgh School website at
Tuition is on a SLIDING SCALE of $95 - $130.
Each purchase of a course purchases a scholarship for a student in need.
Classes are on Wednesday afternoons in SEPTEMBER 3:30 - 4:45pm EST.
It is important that you are able to attend all four classes.
All classes meet on the video conferencing platform Zoom.
Once I receive your tuition payment and you complete this form, you will receive a confirmation email with the link to our ZOOM class, and your registration for the Koru app and details about the course texts.
Parent Phone Number ***I will only call you if you register for a class and I am not hearing back from you via email.
Classes are on Wednesday afternoons in SEPTEMBER 3:30 - 4:45pm EST. SEPTEMBER 9, 16, 23, 30
YES! I can you attend all 4 classes.
I may have to miss a class due to travel. I can let you know in advance. (Recordings of class can be made available)
***Please pay tuition or request a scholarship before completing this form. I :
Paid Tuition Via PayPal to the address firstname.lastname@example.org
Paid Tuition Via Venmo to the address email@example.com
Need to make other arrangements. If you are choosing this option please email me: firstname.lastname@example.org
Requested a scholarship and have filled out the form.
Please tell me how you found out about the class.
A friend sent me one of your emails
Via the Mindful High School Website
So you can stay informed about upcoming free meditation events, online classes, as well as other opportunities and resources, may I add you to my mailing list?
I already receive emails.
Not at this time.
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