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Registration Form

 

PARENT’S NAME___________________________________________________

 

STUDENT’S  NAME_________________________________________________

 

ADDRESS_________________________________________________________

 

CITY______________________________      ZIP__________________________

 

PHONE_____________________________  Home       Cell

 

EMAIL ADDRESS___________________________________________________

 

SCHOOL ATTENDING_________________________________________________

 

CURRENT GRADE  ________________

 

Test: (check appropriate month)

___September            ____February

___October                  ____April

___December              ____June

 

PAYMENT-----CASH ________      

                      CHECK_______ (Make checks payable to ACT Summer Academy, LLC)

 

MAIL YOUR REGISTRATION AND PAYMENT TO. . .  

 

              ACT SUMMER ACADEMY, L.L.C.                

744 Forder Crossing

St. Louis, MO 63129

                      

You will receive an email confirmation when registration form and payment are received.

 

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