Adarsha Academy Registration Form

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Program Registration Form

Student Information

Student Name *

Student's Grade *

Program Selection (select all that apply)

Robotics

Jr FLL Grades (K - 3)

FLL Grades (4 - 8)

VEX Elementary, Grades (3 - 5)

VEX Middle School, Grades (6-8)

VEX EDR - Middle and High School (7 - 12)

Math Programs

Academic and Competitive Math, Grades (K-6)

Abacus Program

Personalized Math Tutoring (Algebra 1, Algebra 2, Calculus etc)

Coding Programs (Grades 1 - 10)

Python Graphics (Level 1)

Game development with Python (Level 2)

Advanced Python Programming (Level 3)

Learn Web Development

AP Computer Science - JAVA

PSAT/SAT/ACT Coaching

SAT/ACT

PSAT

Preferable Time Slot 1 *

Preferable Time Slot 2 *

Preferable Time Slot 3

Please indicate any other time that would work for you.

Parents Information

Father's Name *

Mother's Name *

Cell Phone 1 *

Cell Phone 2

E-Mail Address 1 *

E-Mail Address 2

Address *

Photo Release

By agreeing below, I hereby grant permission to Adarsha Academy LLC and the employees the right to take photographs and videos of student mentioned in this form during the class/course activities and use that media for publicity, advertisement, and on social media

I agree

Clear selection

Program Fees (Office Use Only)

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