Course Registration Form

Student's First & Last Name

First Name Last Name

Grade

School

Address

Address1

Address 2

City

State

Zip

Course 1

Courses Applying

Course 2

Course 3

Allergies if Any

Parent 1 / Guardian (tuition responsible party)

First Name Last Name

Phone : xxx-xxx-xxxx

Email

Parent 2 / Guardian

First Name Last Name

Phone : xxx-xxx-xxxx

Email

Reffered By

How did you find us

Additional Instructions for MyExamsPrep

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Terms & Conditions:

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a) Tuition once paid is non-refundable and non-transferrable

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b) All disputes are subject to jurisdiction of Loudoun County, VA

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c) 30 days written notice is required when discontinuing a course

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d) Returned checks will be charged $25 additional

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By clicking the REGISTER button, I certify that I have read and agree to the above terms & conditions. Tuition can be paid in person at the institute before the first class.

Registration

COURSE REGISTRATION FORM