Declare Registration

Declare Enrollment

Parent Name(Required)

First Last

Parent Email(Required)

Parent Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent Phone(Required)

How many students are you enrolling?(Required)

What grade is your student in?(Required)

What grade(s) are your students in? (Check any that apply.)(Required)

9th

10th

11th

12th

Student Name(Required)

First Last

Student Email(Required)

Student Date of Birth(Required)

Second Student's Name(Required)

First Last

Second Student's Email(Required)

Second Student's Date of Birth(Required)

Third Student's Name(Required)

First Last

Third Student's Email(Required)

Third Student's Date of Birth(Required)

Fourth Student's Name(Required)

First Last

Fourth Student's Email(Required)

Fourth Student's Date of Birth(Required)

Fifth Student's Name(Required)

First Last

Fifth Student's Email(Required)

Fifth Student's Date of Birth(Required)

Please select your timezone.(Required)

Declare Enrollment (Required)

Price: $549.00

Total

PAYMENT SECURED BY STRIPE.

Credit Card(Required)

Card Details

Cardholder Name