Parent's Name (if under 18)

Student's First Name

Student's Last Name

Email Address

Phone Number

Number of Classes You Would Like to Upgrade to Per Week
select membership option30 minute class x 2 ($31/wk)45 minute class x 2 ($33/wk)60 minute class x 2 ($35/wk)60 Minute Class x 1 and 45 minute Class x 1 ($34/wk)Unlimited Classes of Any Type($47.5/wk)

How Long Should We Make this Change For?
select time optionUntil the Main Gradings on the 15th/16th of JuneUntil the Make Up grading on the 22nd of JuneUntil I Change it Back by Sending an Email

I am aware my payments for classes will be altered according to the form above