Hypatia Academy Student Enrollment Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Student Name *

Student Email *

Student Phone Number for Messages *

Student Instant Messenger *

Parent Name *

Parent Email *

Parent Phone Number *

Are you male or female? *

Male

Female

When is your birthdate? (Note that month comes before day in the form.) *

YYYY

Why do you want to study Python? *

PARENTAL CONSENT Ask your parents to here to acknowledge that they give us permission to ask for your personal information on this Student Interview Request form and attend our online computer training classes. Then write that permission on a piece of paper and have them sign it. Then email it to werowe@walkerrowe.com. You cannot attend any classes without this permission. *

I give my child permission to supply the information on this form to Hypatia Academy and have emailed a signed copied of this permission to werowe@walkerrowe.com..

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Hypatia Academy Cyprus.

Does this form look suspicious? Report

Forms