*Parent's Name

*Mailing Address

*City *State *ZIP

*Parent Daytime Phone

*E-Mail Address

*Today's date JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 1st2nd3rd4th5th6th7th8th9th10th11th12th13th14th15th16th17th18th19th20th21st22nd23rd24th25th26th27th28th29th30th31st 20122013

I am responsible for the payment of all fees for this account. I understand the registration fee is non-refundable and is to be paid each school year beginning July 1st. My student will be supervised during study time by a parent or a responsible adult who will not allow the student to copy answers from the score keys. I agree to follow the procedures taught in the Parent/Supervisor Training Packet. I will keep all tests and test keys in a secure place inaccessible to the student. I will grade the tests and return them promptly at the end of each quarter.

I agree to these conditions.

Name of Parent or Guardian

ID # Name Grade

Birthdate JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 1st2nd3rd4th5th6th7th8th9th10th11th12th13th14th15th16th17th18th19th20th21st22nd23rd24th25th26th27th28th29th30th31st 2008200720062005200420032002200120001999199819971996199519941993199219911990198919881987 Registration: $50.00

ID # Name Grade

Birthdate JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 1st2nd3rd4th5th6th7th8th9th10th11th12th13th14th15th16th17th18th19th20th21st22nd23rd24th25th26th27th28th29th30th31st 2008200720062005200420032002200120001999199819971996199519941993199219911990198919881987 Registration: $40.00

ID # Name Grade

Birthdate JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 1st2nd3rd4th5th6th7th8th9th10th11th12th13th14th15th16th17th18th19th20th21st22nd23rd24th25th26th27th28th29th30th31st 2008200720062005200420032002200120001999199819971996199519941993199219911990198919881987 Registration: $30.00

ID # Name Grade

Birthdate JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 1st2nd3rd4th5th6th7th8th9th10th11th12th13th14th15th16th17th18th19th20th21st22nd23rd24th25th26th27th28th29th30th31st 2008200720062005200420032002200120001999199819971996199519941993199219911990198919881987 Registration: $20.00

Parents, August and September are our busiest months of the year. If you re-enroll during those months, you will have a longer wait to receive your curriculum. If you're in a hurry, enroll early! We begin sending out curriculum for the new school year on July 1st.

Note: Registration and Tuition must be paid before curriculum is sent. For amounts, see price list on Registration and Fees page.

Call (309) 663-4477 with credit card information