Registration Form
Summer 2008
Click the "CTRL +P" to Print
Student Information:
___________________________________________________________________________________
(Student First Name) --------------(nickname (if any))------------------- (Last Name)
School ________________________ Grade (Rising)__________ Age _________
 
Parent/Guardian Information:
___________________________________________________________________________________
(Father/Guardian First) ------------------- (Last Name) ---------------------------- (Relation if not Father)

____________________________________________________________________________________
(Mother/Guardian First) ------------------(Last Name) ------------------------------ (Relation if not Mother)
___________________________________________________________________________________
(Street Address)--------------------------------- (City) ------------------------(State) -------(Zip)

Phone (Day): (____)___________________ Phone (Eve): (____)___________________
Phone (cell) : (____)___________________ Phone (cell) : (____)___________________
Email (Parent) ___________________________________________________
Alt. Email (Parent)_________________________________________________
 
Sessions:
Select a session (check one): Seats are reserved on a first come first served basis.

____HS-1a (High School/College :: June 16-27, 2008 :: 9:00-11:30am)
____HS-1b (High School/College :: June 16-27, 2008 :: 1:00-3:30pm)
____HS-2a (High School/College :: July 7-18, 2008 :: 9:00-11:30am)
____MS-1 (Middle School :: July 7-18, 2008 :: 1:00-3:30pm)
Payment Info:

Check: Please make check payable to “Study Skills Institute” and remit with registration form to:

Study Skills Institute, 712 Richmond St Raleigh, NC 27609

Credit: Card Type: (Visa / MC / Amer. Ex / Other________________________________________)

Name on Card: _________________________________________________________________

Card # : _______________________________ Exp (____/____) 3 digit code (back of card)_________

______________________________________________________________________________
Billing Address (if different from above)

Refunds
Tuition Deposits are non refundable. Tuition Fees exceeding the deposit are non-refundable except in cases where withdrawal is beyond reasonable control (e.g. serious illness). In such cases, a refund (prorated weekly) may be given after review of a written request. No refund will be given for voluntary withdrawals or expulsions from class. The director of training reserves the right to expel a student from the course immediately if the student engages in behavior disruptive to the class. Full refunds will be given if a requested session is not available or cancelled for any reason (e.g. teacher illness).

Signed:

__________________________________________________________________________
(Father / Mother / Guardian) ------------------(Print name) ----------------- (Date)