Classroom Registration – E=MC2

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Classroom Registration Form

Completion of this form does not guarantee acceptance into course. Registration is $50 for the first class and an additional $5 per class and per student. Upon completion of this form the registration fee will need to be collected via PayPal. This fee is NOT total payment for classroom experience. This fee is for Higher Ground, where the classes will be held. Future payments will be for E=MC2.

Number of Registrants *

Student Name *

Second Student *

Third Student *

Fourth Students *

Total Number of Classes

Total Number of Classes

Total Number of Classes

Total Number of Classes

Guardian Name *

Address *

Primary Guardian Cell Phone *

Capable of Receiving Text Messages *

Yes
No

Secondary Contact Cell Phone

Capable of Receiving Text Messages

Yes
No

Student's Cell Phone Number

Capable of Receiving Text Messages

Yes
No

Guardian's Email Address *

Student's Email Address *

Food Allergies or Medical Issues *

Classes *

Physical Science
Biology
Chemistry
Anatomy and Physiology
Algebra 2
American Political Systems
Intro to Economic (Fall Semester)
World History
US History I

Total

$ 0.00

Phone

© E=MC2 (Educational Management Coordination and Consulting) – 2020

Contact Us:

Phone: 856-209-4344

Email: beginyourjourney@unlockyoureducation.com

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