Form Test 2

Home Form Test 2

Parent / Guardian Information
Name*
First Last
Email*
Phone*
Address*
Street Address City State ZIP Code
How many students are you registering now?*
- 1
- 2
- 3
Student Info
Name*
First Last
Cell Phone
Email
Grade in Fall 2020*
Name of School*
Student #2 Info
Name*
First Last
Cell Phone
Email
Grade in Fall 2020*
Name of School*
Student #3 Info
Name*
First Last
Cell Phone
Email
Grade in Fall 2020*
Name of School*
Registration Fee
Student Fee
Price: $325.00
Student #2 Fee
Price: $325.00
Student #3 Fee
Price: $325.00
RegFee-Pmt Plan Placeholders
Student Fee
Student #2 Fee
Student #3 Fee
Scholarship Donation (optional)

Applied toward program scholarships, tax-deductible
Total
$0.00
Total Due
Total2
$0.00
Payment Method*
- Credit Card
- Pay by Check
Financial Assistance
If you're in need of financial assistance with the registration fee, we offer options for a Payment Plan (pay over time) or Scholarship (reduction in amount). Please choose one below. Then, whatever amount you are able to pay now is fine. Use the Notes box as needed to elaborate on your request.
Request for Assistance
Amount You Can Pay Now

Please enter an amount you feel comfortable paying now. We will then follow up to arrange financial assistance for you.
Notes
Add any relevant notes about your request or circumstances (optional)
Total for Today
$0.00
Total - Credit Card and 0
This is a hidden value used only to set as a condition for an email notification. If the value is "0," a specific email and confirmation will be sent. The "Total" product field is not an option for email.
Total2 TEST - Credit Card and 0
This is a hidden value used only to set as a condition for an email notification. If the value is "0," a specific email and confirmation will be sent. The "Total" product field is not an option for email.
Total (email trigger)
NOTE: Upon submission you will be taken to PayPal where you can pay by credit card (but it does NOT require you to have a PayPal account).
- NOTE: Upon submission you will go to a page with information on paying by check, and you will receive an email confirmation with the same.
Phone
This field is for validation purposes and should be left unchanged.

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Form Test 2

Parent / Guardian Information

Student Info

Student #2 Info

Student #3 Info

Registration Fee

RegFee-Pmt Plan Placeholders

Financial Assistance

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