High School Programs Form - Maverick Learning Centre

Subject

Select the course you want to register for

Select the course you want to register for

Select the course you want to register for

Select the course you want to register for

Select the course you want to register for

Email ID

Phone Number

Postal Code

Student's First Name

Last Name

Birth Date

Current Grade

Current School

Student's Gender

Preferred Appoitment Date

Time

Do you give us permission to use the student's photo or video taken during the class to promote future classes/events?

Yes No

How did you hear about this program?

Website Friend Advertisement Facebook / Instagram

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