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Vivian Kaeppel Government & Econ. Registration Form
MrsK4FridaySchool@gmail.com
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Student Name
*
Your answer
Student Date of Birth
*
MM
/
DD
/
YYYY
Student Grade Level
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Student Home Address
*
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Student Email (if applicable)
*
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Student Cell Phone (if applicable)
*
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Special Needs or Medical Conditions (Please specify)
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Father
*
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Mother
*
Your answer
Parent(s)' Address (if different from above)
*
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Home Phone Number
*
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Mother's Cell Number
*
Your answer
Father's Cell Number
*
Your answer
Mother's Work Number
*
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Father's Work Number
*
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Emergency Name and Phone Number
*
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Payment Options
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Choose (1) Frequency and (2) Method of Payment
Monthly ($50 supply fee + 9 $50 monthly payments = $500)
By semester ($50 supply fee + 2 $200 semester payments = $450)
By year ($50 supply fee + 1 $400 annual payment = $450)
Cash
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Other (by arrangement)
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