Junior Levels: 2 & 3

Section A: Student General Information

*Gender

Male

Female

How did you hear about us? (or recommended by…)

*Initial

Contract Acceptance

Please take note of the important information set out in our Financial Information, Code of Conduct,Terms and Conditions and Privacy Policy.

I have read and agree to the information set out in the links above.

I, the undersigned, have read and understand the contents in this enrollment and registration agreement and acknowledge receipt of a copy. It is further understood and agreed that this enrolment and registration agreement supersedes all prior or contemporaneous verbal or written agreements and may not be modified without the written agreement of the student and the Centre Official. I also understand that if I default upon this enrolment and registration agreement, I will be responsible for payment of any collection fees or attorney fees incurred by The Collective Genius Centre.

My signature below signifies that I have read and understand all aspects of this enrollment and registration agreement and do recognize my legal responsibilities regarding this contract.

*Student Signature

*Parent/Guardian Signature

Enrollment and Registration

Section A: Student General Information

Section B: Parent/Guardian Contact Information

Primary Contact Parent/Guardian

Secondary Contact Parent/Guardian

Section C: Emergency Contact Information

In Case of Emergencies Contact:

Section D: Special Needs and Medical Conditions

Section E: Tuition Information

Please specify methods of tuition you would be interested in (you may select more than one option):

Contract Acceptance