***PLEASE NOTE*** If you click yes your student will automatically be placed on the roster.  But their spot in the class will not be guaranteed until you complete the checkout process.
Contact Information
Please enter the contact info for who will be paying the bill. If the student is a minor, please enter the guardian's contact info.

First Name(s) *
Last Name *
Address 1 *
Address 2
City *
State *
ZIP *
*
Email/Username *(for example: [email protected])
Additional Emails(for example: [email protected], [email protected])

Password
Please make a note of your email-address/username above and the password you enter below. They will be used to log into your account in the future.

In order to provide the most secure environment possible, all passwords must:

  1. Include at least one upper case letter (i.e. A-Z)
  2. Include at least one lower case letter (i.e. a-z)
  3. Include at least one number (i.e. 0-9)
  4. Include at least one special character (i.e. @#$%^)
  5. Have at least 12 characters that are not spaces

Password *
Re-type Password *

How did you hear about us?
More Details

Emergency Contact Information
Who should we contact, other than the contact listed above, in case of an emergency?

Emergency Contact Name(s)
Emergency Contact Phone(s)
* = Required Fields
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