Home-School ASL Class
Course Facilitator ~ Mrs. Shelby Miller
Classes held in New Braunfels, Texas
Student Registration Form
If you are enrolling more than one student, you must complete this form for each individual student.
Students Full Name *
First, Middle, and Last
Your answer
Students Gender *
Students DOB *
01/01/****
Your answer
Academic Grade Level *
2020-2021 enrolling year
Your answer
Parents Names *
Your answer
Physical Address *
Please list your full address, to include your city and zip
Your answer
Parent Contact Number *
Your answer
Student Contact Number *
I encourage students to text or call with questions, as they need to
Your answer
Parent Email Address *
Parent's primary communication address for class information, course progress, updates, and homework help
Your answer
Students Email Address (Cannot be the same as parent email) *
This is required for student access to the online course interface
Your answer
Course Student is Enrolling in *
Required
Tuition for Single Student
Registration Fee - $35.00

PAID IN FULL PAID BY SEMESTER PAID MONTHLY
ASL I $1250.00 $625.00 / Semester $125.00 / Month
ASL II $1250.00 $625.00 / Semester $125.00 / Month
Multi-Family Discount
Registration Fee - $35.00 for each student enrolling

ASL I

Student 1 - $1250.00 / Full $625.00 / Semester $125.00 / Monthly
Student 2 - $1150.00 / Full $575.00 / Semester $115.00 / Monthly
Student 3 - $1050.00 / Full $525.00 / Semester $105.00 / Monthly

ASL II

Student 1 - $1250.00 / Full $625.00 / Semester $125.00 / Monthly
Student 2 - $1150.00 / Full $575.00 / Semester $115.00 / Monthly
Student 3 - $1050.00 / Full $525.00 / Semester $105.00 / Monthly
Registering More Than One Student From Your Household?
This is Student Number (this is for the mutil-family discount)
Registration Fee (Non-Refundable) *
Due immediately to hold students place within the class
Required
Course Tuition *
Choice of Payment Plan
Required
Tuition (Only Payable by Cash or Check) *
Fall Semester -or- 1st monthly tuition installment is due by August 5th. If registering after this date, tuition is due no later than August 24th - at Back-To-School night.
Required
Comments
Any comments or other information to add to the information given above
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.