AL-ILM Weekend School 2024-2025 Full Academic Year

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Parent/Guardian

Spouse/Emergency Contact

Waivers

Students

Payment Information

Parent/Guardian Information

(Fields marked with * are required)

Email *

Confirm Email *

Phone *

First Name *

Last Name *

Address *

City *

State *

Zipcode *

Country *

Household Income Per Year *

Number of people in the household *

I am interested in PTO.

Spouse/Emergency Contact

(Fields marked with * are required)

Email *

Confirm Email *

First Name *

Last Name *

Phone *

Create a user record for the Portal

Check the box to create a user account for the Spouse/Emergency Contact. They will receive email instructions to access the Portal.

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Waivers

(Fields marked with * are required)

Code of Conduct

I have read and I agree to the Code of Conduct.

Students Information

(Fields marked with * are required)

Student 1

Name:

Gender:

Date of Birth:


. . .

First Name *

Last Name *

Date of Birth *

Must be 4 years old on August 30th, 2024 and they must not be more than 16 years on August 30th, 2024.

Gender *

Level *

If you do not see a level that your child attends, the class for that level in our school is already full.

T-Shirt Size

Food Allergies

Does Your Child Have Any Medical Needs We Should be Aware of? (Optional)

Are There Any Supports or School Accommodations Your Child Needs in Order to Be Successful? (Optional)

Notes

Payment Information

(Fields marked with * are required)

Payment Plan *

Payment Details

Secured Online Transaction

Card Number *

Exp. Month *

Exp. Year *

CVC *

Zipcode *

Cardholder Name *

Billing Details

Same as parent address

(Check the box if the billing details are same as parent information)

Email *

Phone Number *

Address *

State *

City *

If you need any further assistance

Contact our support team or Submit an Issue