ecae registration
Session:
(for math classes only)
Class: *
Required
Student FIRST Name: *
If you wish to register more than one student, please complete a registration form for each one. Thank you.
Your answer
Student LAST Name: *
Your answer
Student Birthdate: *
example: 07/19/2001 (we ask because school grade does not always equal similar age ranges)
Your answer
Student Gender: *
Grade Level: *
School Attending:
Your answer
Parent(s) FIRST Name:
Your answer
Parent(s) LAST Name:
Your answer
Street: *
Your answer
City: *
Your answer
Zip Code: *
Your answer
Email address: *
Your answer
Home Phone:
Your answer
Cell Phone:
(In case of emergency during class time.)
Your answer
Payment:
~ Please mail your check payments to the address on the next screen for quicker processing. Thank you!
Note:
Your answer
Thank you for registering!
Payments are entered into our system when they are received, no notification is sent.
Math Class instructor will email you before the first class with information.
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