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First Name:
Last Name:
Address Line 1:
Address Line 2:
City:
State:
Zip Code
Student Phone Number:
Payment Method:
STUDENT INFORMATION
PARENT/GUARDIAN INFORMATION
Parent First Name:
Parent Last Name:
Parent Phone Number:
(Optional 2nd Parent/Guardian Contact Information)
Parent First Name:
Parent Last Name:
Parent Phone Number:
Step Two Complete!
You have chosen the following schedule and program option:
-Regular Weekday Afternoon Schedule.
-Classes take place Monday through Thursday from 4pm to 6pm.
-Your class is scheduled to begin on February 6th, 2012 and end March 1st, 2012.
Note: No classes are scheduled for February 20th, 2012 (President's Day Holiday)
-You have chosen Teen Program Option #1 (See Details to the right)
Final Step:
Complete the registration form below by filling in the requested information and clicking the "submit" button. If you choose to pay enrollment fee online please click on the payment link on next page after submitting registration information. If you have any questions please call us at 773-489-2712. Thank you for your enrollment!
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If you are making a payment online: Please click on the payment link on the following webpage after submitting registration information. We have partnered with Authorize.net to provide you with a reputable, safe and secure method of online payment.
Date of Birth:
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Parent Email Address:
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Parent Comments:
(Optional)
After submitting registration information you will receive an email confirmation of your enrollment within 24-48 hours.
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Middle Initial:
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