Mindful High School • Class Registration • SEPTEMBER 2020
Please fill out this form for pre-registration for Mindful High School Online with Myra Smith.

This course is for high school students in grades 9 - 12.

Before completing this form, please make your tuition payment or scholarship request.

Tuition payments can be made via Venmo.com to @myrajeansmith or to Paypal.com to the address myrajeansmith@gmail.com.

The link for scholarship requests is on the
Mindful HIgh School website at http://wwwmindfulhighschool.com

Tuition is on a SLIDING SCALE of $95 - $130.

Each purchase of a course purchases a scholarship for a student in need.

Classes are on Tuesday afternoons in SEPTEMBER 3:30 - 4:45pm EST.

It is important that you are able to attend all four classes.

All classes meet on the video conferencing platform Zoom.

Once I receive your tuition payment and you complete this form, you will receive a confirmation email with the link to our ZOOM class, and your registration for the Koru app and details about the course texts.
Student Name *
Student Email *
Parent Name *
Parent Email *
Parent Phone Number ***I will only call you if you register for a class and I am not hearing back from you via email. *
Classes are on Tuesday afternoons in SEPTEMBER 3:30 - 4:45pm EST. SEPTEMBER 8, 15, 22, 29 *
***Please pay tuition or request a scholarship before completing this form. I : *
Please tell me how you found out about the class. *
So you can stay informed about upcoming free meditation events, online classes, as well as other opportunities and resources, may I add you to my mailing list? *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy