Early Childhood Program Deposit Fee – Registration Page

Student Information

Student Name
Birth Date
Home Address
Home Phone
Email Address
Parent 1 / Guardian
Work Phone
Cell Phone
Parent 2 / Guardian
Work Phone
Cell Phone
Emergency contact: (Name)

Credit Card Information

Credit Card
Expiration Date
Postal Code

$500 Deposit Required for Homeschool Connections 

2019-2020 Early Childhood 3-4 Year Old Program

  • I hereby enroll the child named above and agree to ALL terms and conditions outlining the requirements of the Homeschool Connections, NYC.
  • Leap Tutoring Academy reserves the right to dismiss any student whose behavior is disruptive to the day program. In such cases, there will be no refund.
  • I grant to Leap Tutoring Academy and to its employees the right to photograph my child and to use these photographs or video recordings for print or electronic publishing.
  • A fully completed emergency form MUST be on file in the prior to the student’s first day.  It will be provided to you upon registration.
  • No refunds for the program deposit will be granted.

I have read the above statement, and the terms and conditions listed, and agree to all terms indicated.

By typing my name I agree to the above with my digital signature.