Student's Name:
Street Address:
City/State:
Home Phone:
E-mail:
Parents' Marital Status:	Married Single Divorced Widowed Separated Other
Mother
Name:
Occupation:
Daytime Phone:
Father
Name:
Occupation:
Daytime Phone:
Student
Sex:	Male Female
Date of Birth:
Please register my child for:
Classes:	TBD College Science for 3-4 year-olds - First start: 2008-01-08 18:00:00 EST Лепка I - First start: 2007-11-22 13:30:00 EST Физика для малышей. 4-6 лет. - First start: 2007-11-22 14:30:00 EST Русский язык для малышей. 2-3 года. - First start: 2007-11-22 15:30:00 EST Русский язык для малышей. 4-5 лет. - First start: 2007-11-26 14:30:00 EST Тайны анатомии. 4-6 лет. - First start: 2007-11-22 17:30:00 EST Private Tutoring $50/hr
Comments On: Courses Meeting Times etc.
School Policies:
Payment Policy:	TBD
Refund Policy:	You can terminate this agreement at any time
I authorize Amusing Science Academy to use still or video photographs of my child for publicity purposes. By submitting this application I indicate that I have read and agreed with all of the provisions of this agreement