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Registration Form
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* Indicates required question
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Current Grade
*
Your answer
School Name (for non-khalsa school students)
Your answer
E-mail address
*
Your answer
Parent's Full Name
*
Your answer
Relationship with student
*
Mother
Father
Other:
Select month(s):
*
July 5 - July 30
August 2 - August 27
Both months
Time slot
*
8:30-4:30 (full day)
8:30-12:30
12:30-4:30
PAYMENT AUTHORIZATION
$250 = 2 months
$140 = 1 month
(Fees are the same for full day and half day students)
Name of Card Holder
*
Your answer
Billing Address
*
Your answer
Telephone
*
Your answer
Visa/Master Card Number
*
Your answer
Expiry Date
*
Your answer
I authorize Khalsa School to charge the above credit card for the summer school fees.
*
Yes
No
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