Homeschool Class Registration Form
1. Love of Literature: Tuesdays & Wednesdays 9:30 - 12:00 (January - May)
2. Music & Art Appreciation: Wednesdays, 12:00 - 12:45 (January - May)
3. Social Lunch Break, Tuesdays, 12:00 - 12:30 (January - May)
4. Deep Dive, Tuesdays, 12:30 - 2:30 (January - May)
Email address *
Student Name *
Your answer
Registering For (check all that apply):
Age/Grade *
Your answer
Parent/Guardian Name(s) *
Your answer
Parent/Guardian Phone(s) *
Your answer
Parent/Guardian Email(s) *
Your answer
Address (street, city, zip) *
Your answer
Emergency Contact Person and Contact Info *
Your answer
Student's Strengths and Enjoyable Activities *
Your answer
Area(s) of Weakness/Concern/Support May Be Needed *
Your answer
Medical Information (include allergies, diagnosis, or any other areas of concern): *
Your answer
Any information you would like the instructor to know about your student:
Your answer
After registration is received you will receive a separate email with your payable invoice. Payments may be made by credit card, check, or cash. Payments are due on the 20th of the month for the next month of service. Please select all of your interested classes. * Must have at least 6 students. Discounted rate for 8 or more students.*
I understand that I will not be refunded for missed sessions. You may cancel your monthly sessions by notifying EtB in writing (email) by the 20th before the start of the new month.
I agree to having my child's photo taken and used in marketing/social media sites. (No names will be used.)
A copy of your responses will be emailed to the address you provided.
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