Registration for Classes with Christie Miller

Please send this form to:
2818 Martin Road, Bellingham, WA  98226       360-966-0203


STUDENT NAME(s) _______________________  
Grade ____________Age________


Parent’s Name(s) ________________________________


Address ____________________________________


City _________________   Zip _________


Home phone___________________________


Cell Phones ______________________________________


Email address _____________________________________


Registering for what class:

Jumpstart English (6-7) _________________

Horizons (4-5)__________________

 Focus English (7-8)   ________________
Spectrum English (8-10) ________________

High School English Concepts (10-12) __________________

American Literature  (11-12)_________________


Payment: ($25 deposit)  _________________________


Are you home schooled?  YES    NO

How long have you home-schooled?  __________


Other educational opportunities presently or in the past:

______________________________________________


Any special needs you want me to know?