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Online Signup

Dear student please complete steps 1 through 3 to signup for a classroom and have your seat reserved. Our web site is updated Real-Time so to assure accuracy of the information. Please make sure to include your email address because your enrollment confirmation will be sent there.

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Student Information
First Name:	*	Student Email:	*
Middle Name:		Home Phone:	*
Last Name:	*	Student Cell Phone:
Address:	*	Parent Email:
City:	*	Wear Glasses/Contacts:
State and Zip:	*	How Did You Hear About Us:
Date Of Birth:	*	Gender:
DL/Permit #:		High School:
DL/Permit Expiration:		Special Needs:

* - Required

Payment Information		We Accept:
Billing First Name:	*	Credit Card Type:	*
Billing Last Name:	*	Card Number:	*
Billing Address:	*	Expiration:	*
Billing City:	*	Security Code (What is This?):	*
Billing State and Zip:	*	Payment Amount($):	*