Please read the enrollment policy before completing registration.

REGISTRATION FORM

Please fill out registration form, print and return to QLK Learning Center, Inc. along with your payment.

QLK Learning Center, Inc. has the right to cancel sessions due to low enrollment. In such an instance, you can apply your payment to another session or semester.

LAST NAME:
FIRST NAME:
AGE: GRADE ENTERING: SEX:
ALLERGIES:
MEDICAL CONDITIONS:
PARENTS' NAMES:
ADDRESS:
EMAIL:
HOME PHONE:
CELL PHONE: BUSINESS PHONE:
EMERGENCY CONTACT: PHONE: