Adarsha Academy Registration Form
Program Registration Form
Student Information
Student Name *
Your answer
Student's Grade *
Program Selection (select all that apply)
Math Programs
Coding Programs (Grades 1 - 10)
Preferable Time Slot 1 *
Preferable Time Slot 2 *
Preferable Time Slot 3
Please indicate any other time that would work for you.
Your answer
Parents Information
Father's Name *
Your answer
Mother's Name *
Your answer
Cell Phone 1 *
Your answer
Cell Phone 2
Your answer
E-Mail Address 1 *
Your answer
E-Mail Address 2
Your answer
Address *
Your answer
Photo Release
By agreeing below, I hereby grant permission to Adarsha Academy LLC and the employees the right to take photographs and videos of student mentioned in this form during the class/course activities and use that media for publicity, advertisement, and on social media
Program Fees (Office Use Only)
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