Online Enrollment

Online Enrollment Form
Please complete an online form for each student.
Payment must be received before classes can be guaranteed.

Please submit payment to:
GA-EPH, 4937 Lighthouse Pointe, Acworth, GA 30101.

If you register by the deadline, you can save 10% of the class fees.
If you pay via paypal, please add 3% to your total to cover the paypal fee.

Include the Admin Fees: $25 per session/per family or $75 per year/per family.

Families must sign a Participation Agreement each year.

Enrollment Information

Please complete a form for each student.

Student Name:
Student Age:
First Name (Parent):
Last Name (Parent):
Address Street 1:
Address Street 2:
City:
Zip Code:	(5 digits)
State:
Home Phone:
Cell Phone:
Special Instructions or Needs:
Emergency Contact:
Emergency Phone Number:
Email:
Adminstration Fee:

10:00 Class:
11:15 Class:
1:00 Class:
2:15 Class:
	Approval to have photos in yearbook
	Approval to have personal information listed in directory
Payment Method:
Comments:

You will receive an invoice within 2 days after you submit your enrollment. If not, please contact Teri at teriverhine@gmail.com.