Reading Adventures Summer 2012 Registration Form

Please submit one form per child enrolled. Thanks.



Student's Name                                                                        DOB                                          Age

Will you be paying in full?

Will you be paying in 2 monthly installments?                                       Automatic debit is required with this option.                                    
Currently Attending School at                                                                              

Current Grade        Grade Entering Fall 2012         

Please select the age group and all days attending.

Preschool/Kindergarten/Elementary Programs ages 3-8 years





Please indicate any concerns or specific goals for the program.







Auto Debit is required when choosing the installment plan. Debits will be required upon registration and again on July 18th.


E-signature

E-mail

Referred by



                      CREDIT CARD AUTHORIZATION

Name on Card

Type of Card

Card Number

Expiration Date 

By submitting this form, I agree to have Wild About Learning charge my credit card for the following charges:








Paypal and checks are also accepted. Once you submit this form, go to our Payment Center link at the top of our website.

Class confirmation will not be made until all fees are paid.
Annual Enrollment Fee of $40 and $250 for Tuition paid in full
$250 Tuition (already enrolled)
Annual Enrollment Fee of $40 and $150 for Tuition's first of 2 installments
Wed. Ages 3-6yrs. 3:30pm - 5:30 pm 10 weeks $250 pay in full or 2 equal payments of $150
Wed. Ages 6-8yrs. 3:30pm - 5:30 pm 10 weeks $250 pay in full or 2 equal payments of $150
Fri. Ages 6-8yrs. 3:30pm - 5:30 pm 10 weeks $250 pay in full or 2 equal payments of $150
Fri. Ages 3-6yrs. 3:30pm - 5:30 pm 10 weeks $250 pay in full or 2 equal payments of $150