August 20 – August 24, 2018  –  Fusion 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

Register for the August Fusion Program Below

Monday, August 20th thru Friday, August 24th

1:00pm – 4:00pm

Program Price  $450 + $75 Materials Fee = $525 Total

  • I hereby enroll the child named above and enrollment is for the time specified.
  • 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.

By clicking the REGISTER link below you agree for the program fee of $525.00 to be charged to your credit card.

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.