Homeschool Registration

Homeschool Individual Application

Registration: $100 for Individual Sessions
Registration is non-refundable unless space is no longer available.

Parent Information

Parent 1 Full Name

Parent 1 Phone Number

Parent 1 Email

Parent 2 Full Name

Parent 2 Phone Number

Parent 2 Email

Student Information

Student Name

Birthday

What are your goals for homeschooling your child with the support of The Brainery?

Additional information about your child that you would like The Brainery to know. (i.e Disbiabilities, Illnesses, Behaviors, etc.)

Agreement

I have agreed to submit this application by electronic means. By signing this application electronically, I certify under penalty of law that my answers are correct and complete to the best of my knowledge. I certify that I understand the questions and statements on this application and that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

Your Signature

I want to subscribe to the newsletter.

Registration Successful. If you have not spoken to a consultant expect a call Tuesday or Thursday to discuss the next steps.

Homeschool Individual Application

Registration: $100 for Individual Sessions Registration is non-refundable unless space is no longer available.

Parent Information

Student Information

Agreement

Registration: $100 for Individual Sessions
Registration is non-refundable unless space is no longer available.