Homeschool Program for Thursdays/Fridays Fall Session Payment Option
Homeschool Program for Thursdays/Fridays Fall Session Payment Option
Registration 2018 - 19
Deep Nature Connection - Mentoring - Community
Thursday and Friday Home School/ Unschool Programs
9am-3pm
Thursdays - Ages 6-9
Fridays - Ages 10-16
Multiple Locations
Payment Option for Thursdays:
Fall Session $380
Payment Option for Fridays:
Fall Session $380
Parent(s) Information
Name of Parent:
First
Last
Phone
-
###
-
###
####
Email
Name of Parent:
First
Last
Phone
-
###
-
###
####
Email
Address
Street Address
Address Line 2
City
Select a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State / Province / Region
Postal / Zip Code
United States
Country
Emergency Contact Name:
First
Last
Emergency Contact Phone:
-
###
-
###
####
Participant Information
How many participants?
1st Participant Information
Name of 1st Participant:
First
Last
Nickname, if any
Age
Session Payment Option:
Thursday - Fall $380 per session
Friday - Fall $380 per session
2nd Participant Information
Name of 2nd Participant:
First
Last
Nickname, if any
Age
Session Payment Option:
Thursday - Fall $380 per session
Friday - Fall $380 per session
3rd Participant Information
Name of 3rd Participant:
First
Last
Nickname, if any
Age
Session Payment Option:
Thursday Fall $380 per session
Friday Fall $380 per session
4th Participant Information
Name of 4th Participant:
First
Last
Nickname, if any
Age
Session Payment Option:
Thursday Fall $380 per session
Friday Fall $380 per session
5th Participant Information
Name of 5th Participant:
First
Last
Nickname, if any
Age
Session Payment Option:
Thursday Fall $380 per session
Friday Fall $380 per session
Promo Code:
This is a private and secure Online Registration Site
Type the letters you see in the image below.
$
0
Total
+Tax 4.02%