Nsoromma School's Triple Threat Test Prep Registration
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Student's Name *
Current Grade (Spring 2024) *
School *
Student's email *
Student phone
Parent Name *
Parent Phone *
Parent email that is checked regularly *
Address.  Please include CITY and ZIPCODE! *
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Previous ACT or SAT scores (Date taken; Total and subtest scores)
Challenges:  Has the student ever had learning or behavioral challenges or issues that required tutoring, counseling, special classes, 504 Plans, etc.?  If yes, please describe briefly.
POLICIES, EXPECTATIONS & PERMISSIONS

Please indicate your agreement to the statements below by TYPING YOUR INITIALS in the space "Your answer" after each paragraph.  If you do not agree or give your permission, please state that you do not and/or give us a call.  
I understand that this is an in-person course. I will ensure that my teen attends classes on time and has a time and space for home assignments each day after class. Practice after class is critical for mastering the skills and improving test scores.  They will need to bring pencils or pens, a basic calculator (a graphing calculator is NOT necessary), as well as the ACT Study Guide and Triple Threat Test Prep Manual that will be distributed in class. *
I understand that CANCELLATIONS received in writing eight or more days prior to the first class will receive a refund of money paid minus a $50 cancellation fee.  There are no refunds for requests received less than eight days prior to the first class.  However, if the cancellation request is received prior to the first day of class, the amount paid can be applied to another test prep course offered within 12 months.  I understand that there are no future applications of fees on or after the first day of class.   *
I understand that there are no REFUNDS or future applications of fees on or after the first day of class.  There are no refunds for missed classes and no make-up classes or class recordings offered.   *
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I certify that all of the information in this application is true and complete to the best of my knowledge and that I have not intentionally falsified or misrepresented any information.   *
I hereby grant PERMISSION for me/my child to participate in the Nsoromma School, Inc.’s Triple Threat Test Prep Program.  I hereby agree to hold harmless and release Nsoromma, its officers, directors, employees, students and representatives (“Releasees”) from any claims of damage arising from my child’s participation in the program. I have signed this release with full recognition and appreciation of the risks of such activities, including risks associated with transportation to and from Nsoromma School, Inc. *
 I agree that Nsoromma School, Inc. personnel are granted permission to authorize emergency medical treatment if necessary and that such action by persons shall be subject to the terms of this release. I understand that Releasees assume no responsibility for any injury or damage that might arise out of or in connection with such emergency medical treatment.  I further agree that this consent and release shall be construed in accordance with the laws of the State of Georgia. If any term or provision of this consent and release shall be held illegal unenforceable or in conflict with any law governing this consent and release, the validity of the remaining portions shall not be affected. *
MEDIA RELEASE:    I grant my permission to The Nsoromma School, Inc., its representatives, employees or to those whom permission is granted by The Nsoromma School, to make motion or still pictures and television and video tapes including website uploads of these in which I/my child may appear.  I understand that no payment whatsoever will be made to either my child or myself for his/her appearance in these films, photographs or tapes.  It is further understood that these films, photographs and/or tapes are used solely for educational and/or promotional purposes. This consent shall be effective for five years from the date signed or until I withdraw my consent in writing. As evidenced by my (typed) signature below, I have carefully read and fully understand  the terms and conditions of this permission form. *
How did you hear about us?  This will help us know how to best spread the word about our classes. And, we'll thank those who have been ambassadors sharing the news with others.  

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