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Home-School ASL Class

* Required

Course Facilitator ~ Mrs. Shelby Miller

Classes held in New Braunfels, Texas

Student Registration Form

If you are enrolling more than one student, you must complete this form for each individual student.

Students Full Name *

First, Middle, and Last

Students Gender *

male
female

Students DOB *

01/01/****

Academic Grade Level *

2018-2019 enrolling year

Parents Names *

Physical Address *

Please list your full address, to include your city and zip

Parent Contact Number *

Student Contact Number *

I encourage students to text or call with questions, as they need to

Parent Email Address *

Parent's primary communication address for class information, course progress, updates, and homework help

Students Email Address (Cannot be the same as parent email) *

This is required for student access to the online course interface

Course Student is Enrolling in *

2018 - 2020 ASL I & II - 2-year Program - Friday's 1:30pm - 4:00pm

Tuition for Single Student

Registration Fee - $35.00

Multi-Family Discount

Registration Fee - $35.00 for each student enrolling

ASL I

ASL II

Registering More Than One Student From Your Household?

This is Student Number (this is for the mutil-family discount)

Student 1
Student 2
Student 3

$35 Registration Fee (Non-Refundable) *

Due immediately to hold students place within the class
Check By Mail - 1369 Copper Point Dr. NB TX 78130 (must be received within 5 days of this completed form)

PayPal -

Course Tuition *

Choice of Payment Plan

Paying In Full
Paying by Semester
Paying Monthly (Contract of faith must be signed at Open House)

Tuition (Only Payable by Cash or Check) *

Fall Semester -or- 1st monthly tuition installment is due by August 13th

Check By Mail - 1369 Copper Point Dr, NB TX 78130 (Check made payable to Shelby Miller)

Comments

Any comments or other information to add to the information given above