32814961 - Clone of Course Selection Form

2026 Winter Registration
end of Winter Term

MonthDayYear
Date
end of Competition Term

MonthDayYear
Date
today's Date

MonthDayYear
Date
months for Winter term
months for Winter term
Personal Info
Student Name

First NameLast Name
Current Grade Level:
SpringSummerFall-A+BWinter
Parent/Guardian Name:
P/G Email:
P/G Phone Number:
Format: (000) 000-0000.
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 2 Name:
P/G 2 Email
P/G Phone Number
Format: (000) 000-0000.

Payment
Algorithms in C/C++ Class Schedule:
Robotics Projects Class Schedule:
Competiition Meetings Schedule:
# of classes selected:
Sub-Total Fee: $
Discount: $
Final Total: $
Full Payment Now3 Equal Recurring Payments
Due now: $
Parent Signature*

Clear
Date Signed

MonthDayYear
Date

My Subscriptions*

Make Full Payment Now

One-time Payment only

USD one-time payment

3 Equal Payments

with 1st Payment Now

USD for each month

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty: