Adult Education Registration Form Fall 2022

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Fill out the Registration Form, and then complete payment under the Make Your Payment link.

Email *

Email Address (Confirm Email Again) *

Last Name *

First Name *

Middle Name *

Gender *

Male

Female

Other:

Address *

Phone *

Emergency Contact/Number *

Race/Ethnicity *

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Hispanic or Latino

Not Hispanic or Latino

Other:

Birthday *

YYYY

Course *

I have read and understand the refund policies regarding the classes at the Adult Education Center. I also understand that if a course is cancelled due to insufficient enrollment, my registration payment will be refunded. Otherwise, no refund will be provided. Check processing can take up to 6 - 8 weeks. *

Yes

Required

I hereby agree that I will follow the rules and regulations laid down by Henrico County Public Schools and Henrico Adult Education Center. *

Yes

Required

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Henrico County Public Schools. Report Abuse

Forms