Pre-K3 Enrollment Form – Whiz Kid Academy

Step 3 of 3

Parent's Name*

First Last

Child's Name*

First Last

Child's Birthdate*

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

How did you hear about us?*

Choose a Password*

Enter Password Confirm Password

Membership Level:

High Achiever (Pre-K3) - Live classes 2x/week

Membership Level:

High Achiever (Pre-K3) - Live classes 4x/week

Membership Level:

Scholar (Pre-K3) - Live classes 3x/week

Membership Level:

Scholar (Pre-K3) - Live classes 5x/week

Membership Level:

Standard (Pre-K3)

Monthly Tuition (after 7-day Free Trial):

First payment due on: October 3, 2021

Hands-on Kit
$150 (one-time fee)

*One-time fee for Hands-on Kit ($150)/Workbooks ($50) orders will be charged separately after trial period.

Coupon Code

Credit Card*

Your credit card will not be charged today. Payment only due after trial is complete.

Untitled*

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Easy Enrollment Form: Pre-K3