Online Learning Registration Form

Online Learning Registration Form

Financial Literacy Basics Co.
Please fill out a registration form for each child and list the requested program date below. Please pick the start date of each week of the program you wish to enroll the child in. Cost per child is $100.00 USD per week. Invoice will be generated and payment taken online after registration is received. You will receive an email acknowledgement and confirmation following payment.
First Choice

MonthDayYear
Date
Second Choice

MonthDayYear
Date
Name of Child*

First NameLast Name
Date of Birth for Child. Must be between 7 and 18 years old*

MonthDayYear
Name of Parent or Guardian (Must be a parent or guardian)*

First NameLast Name
Address of Parent or Guardian*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number of Parent or Guardian*

Area CodePhone Number
Email of Parent or Guardian*
example@example.com
Signature of Parent or Guardian*

Clear
Please verify that you are human*
Should be Empty: