Hypatia Academy Student Enrollment Form
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Student Name *
Student Email *
Student Phone Number for Messages *
Student Instant Messenger *
Parent Name *
Parent Email *
Parent Phone Number *
Are you male or female? *
When is your birthdate? (Note that month comes before day in the form.) *
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DD
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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. *
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