Learnika Registration Form 2024 - 2025
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Student Name *
Grade *
Which program would you like to register your child to?
*
Required
Parent's name *
Email Address *
Best Phone Number To Contact *
Second best phone number
Specific Health Information

Instructions on medication needs, allergies, and other important information. 
Payment Methods and other important information.
Please make your check payable to:
Learnika
572 College Ave, Palo Alto, CA 94306
 
You can also pay by using (650)224-2230 for Zelle or "tony@learnika.com" If you are using PayPal, please send the payment as "family or friends" as PayPal will charge a 3% service fee if not. 

Enter Electronic Signature *
Please type your name in the box below
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