Keyboarding Class Registration

Cynthia Golemon
cynthiagolemon@gmail.com

512-496-6013

Student Information

First Name *

Last Name *

Gender *

Birth Date +

Age *

Choose Class: *

Fee ($)

ODA Family #

Household / Adult Primary Contact

Relationship to Participant: *

Mother

Father

Guardian

Other Other

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip *

Email Address: *

Phone *

Alternate Phone

Household / Adult Secondary Contact

First Name

Last Name

Phone

Alternate Phone

Email Address

TERMS OF ACCEPTANCE

My family agrees to accept the policies of One Day Academy. We give permission for our child(ren) to be photographed in the course of normal classroom activities and used on classroom websites. We agree to pay the stated monthly tuition fee of $50 for each of our student’s courses, on or before the beginning of each month.

clear

Please submit this form and the $25 registration fee. This fee includes your course supplement fee and your registration fee. Please note these payments are not refundable. Please see information in the course description on the One Day web page. Registration payment can be made online using Credit / Debit or PayPal

www.paypal.me/Golemon

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