Parent/Buyer InformationName* First Last Phone*Additional Phone (if desired)Email* Additional Email (if desired) Student Information:How many students will you be registering?*-Please Select-12345Student Name* First Last Student Date of Birth* MM slash DD slash YYYY Student Age:Student Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 2nd Student Name* First Last 2nd Student Date of Birth* MM slash DD slash YYYY 2nd Student Age:3rd Student Name* First Last 3rd Student Date of Birth* MM slash DD slash YYYY 3rd Student Age:4th Student Name* First Last 4th Student Date of Birth* MM slash DD slash YYYY 4th Student Age:5th Student Name* First Last 5th Student Date of Birth* MM slash DD slash YYYY 5th Student Age:Payment Information:Credit Card*First months tuition is due at the time of registration. Additional two payments will be charged on the same date over the following two months American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Security Code Cardholder Name Total: Price: Total: Price: Total: Price: Δ