Mill Creek Academy ::: SAT Prep, Academic Enrichment, Tutoring

Mill Creek Academy - Printer-Friendly Registration Form - Winter/Spring 2010
Please print this form, and mail it with your payment to: 1544 Washington Blvd., Fremont, CA 94539.

Student Name
Home Address
City
State		Zip
Home Phone
Student E-mail
Student Status	____ New ____ Returning
Home Phone		Student E-mail
School		Grade in Sept 2009
Mother's Name
Mother's Work Phone		Mother's E-mail
Father's Name
Father's Work Phone		Father's E-mail

Class #1 Title
Instructor		Day/Time
ID Number		Tuition

Class #2 Title
Instructor		Day/Time
ID Number		Tuition

Class #3 Title
Instructor		Day/Time
ID Number		Tuition

		Tuition Total
		Amount Enclosed
		Balance Due
Date of Check		Check Number

Comments or Questions