Course Registration

Course Registration

Please complete a separate form for each student
Student Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Gender
Student's Grade as of September 2026
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Mobile Number
Format: (000) 000-0000.

Select Course(s)

Enrollment & Participation Waiver
Section 1: Student & Family Information
Student's full name

First NameLast Name
Date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Grade Level
Classes Enrolled In
Parent / guardian name

First NameLast Name
Phone number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact

First NameLast Name
Relationship to student
Emergency Contact's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent Email Address
example@example.com
Home address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Section 2: Program Agreement
Program Agreement text
Attendance & Commitment
• Classes are held Monday through Thursday, 9:00 to 11:00 AM and 11:30 to 1:00 PM in North Brunswick, NJ.
• I understand that consistent attendance is essential to my child’s progress and to the functioning of the group.
• I will notify the instructor in advance if my child will be absent.
• Inspire Learning, LLC reserves the right to dismiss a student whose attendance significantly disrupts the program.
*Full refunds are available up to 7 days before the semester start date. After the semester begins, tuition is non-refundable. In the event of a documented medical emergency or serious family hardship, families may submit a written request for a partial credit toward a future semester. All requests are reviewed at the discretion of Inspire Learning, LLC. 


Conduct & Community Standards
• I agree to uphold a respectful, inclusive, and supportive learning environment.
• My child will treat all instructors, fellow students, and staff with courtesy and respect.
• Disruptive, disrespectful, or unsafe behavior may result in dismissal from the program without a refund.

Academic Expectations
• I understand that each course has defined learning objectives and assignments.
• My child will receive a formal grade upon course completion, assessed by their NJ certified instructor.
• A certificate of completion will be issued upon successful completion of the course.
• Grades and certificates are based on participation, effort, and demonstrated learning.
Section 3: Health & Safety
I confirm that my child is in good general health and able to participate
Medical / Allergy Information (if applicable):
Known allergies, conditions, or medications staff should be aware of
Parent / guardian signature (health & safety consent)
Section 4: Photo & Media Release
Photo & Media Release
Section 5: Fees & Payment
Fees & Payment text
• I understand that course fees are due prior to the start of the session unless otherwise arranged. • Fees are non-refundable once a course has begun, except in cases of documented medical emergency. • Consulting and transcript fees charged by Aysha Khalid are separate from course tuition and are subject to their own terms, confirmed at time of booking. • Inspire Learning, LLC reserves the right to adjust fees between sessions with advance notice.
Section 6: Release of Liability & Acknowledgment
Release of Liability text
I, the undersigned parent or legal guardian, acknowledge that I have read this Enrollment & Participation Waiver in full. I understand and agree to all terms set forth above. I voluntarily enroll my child in Inspire Learning, LLC and release Inspire Learning, LLC, its instructors, and affiliated staff from liability arising from participation in the program, except in cases of gross negligence.
Parent / Guardian Printed Name
Parent / Guardian Signature
Parent / Guardian Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Student Name
Should be Empty:

Course Registration

Select Course(s)

Payment Methods

Enrollment & Participation Waiver

Section 1: Student & Family Information

Section 2: Program Agreement

Section 3: Health & Safety

Section 4: Photo & Media Release

Section 5: Fees & Payment

Section 6: Release of Liability & Acknowledgment