One Day Academy » Registration

To register for Math classes with Laurie Miller,
mail this form, along with appropriate payment, to:
Laurie Miller | 3508 Apache Forest | Austin, TX 78739

Student #1

Name:	Age:
Email:
Course:	Campus:

Student #2

Name:	Age:
Email:
Course:	Campus:

Student #3

Name:	Age:
Email:
Course:	Campus:

Parent Information

Dad's First Name:	Dad's Last Name:
Mom's First Name:	Mom's Last Name:
Dad's Cell:	Mom's Cell:
Home Phone:
Address:	City: Zip:

Payment Information

One Day Academy Certificate Number:
Check Number:	Materials fee:

Payment is due on or before the 1st of every month.

Parent's signature__________________________________________________________

You must also register your family with One Day Academy.

Registration

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