Individual Application Assistance Sign Up

Parent Name*
First Last
Student Name*
First Last
Address*
Street Address City State ZIP Code
Email*
Phone*
High School*
Package*
- Gold
- Silver
How did you hear about us?*
When is your desired start date?*
Package Payment and Cancellation Policy*
Cancellation Policy: If the client cancels within 24 hours of agreed upon, scheduled meeting time, one hour will deducted from the credit without refund.
- I agree to the Policies and Procedures, Cancellation Policy and payment in full of the above amount.