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Email *
Student FULL Name *
Student Phone *
Student Mailing Address (Address, City, State, Zip) *
Student Course *
Course Start Month *
DISCLAIMER: Per the Illinois License Act: Applicants are to be 18 years of age or older, have completed High School or equivalent course work, have not been convicted of a felony, and be of good moral character. *
Required
PAYMENT: Payment is due prior to the day of the first session. Payment type includes check payable to Crosby Academy and can be mailed to or hand delivered to Crosby Academy at 551 N Mulford Rd, STE B Rockford, IL 61107. *
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