MML Student Registration
- Please complete all sections
- Questions with an asterisk are required
- Once registration is complete and approved, we'll notify you
- You can then sign up for any Modern Minds Learning classes
- Questions: Contact Steve Waterman @ 386-871-0469
Student Last Name, First Name *
Student Address *
Student Birthdate *
MM
/
DD
/
YYYY
Student School Name (2019 - 20 School Year) *
Student Grade Level (2020 - 21 School Year) *
Parent #1 - Last Name, First Name *
Parent #1 Cell *
Parent #1 Email *
Parent #2 - Last Name, First Name
Parent #2 Cell
Parent #2 Email
Which program(s) are you interested in for your child? *
Required
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