Savvy Minds Program Enrollment Form

Program and Payment Selection

Select the program you would like to enroll in 

*For example, a student planning to take Algebra 1 in the Fall 2008 would enroll in our Algebra 1 program this summer to get a head start.

*Programs meet Monday through Friday for 2 weeks

Which method will you be paying by?         

* $100 Early Registration Discount . All courses  $295

Your satisfaction is guaranteed: If after enrolling and attending the first session, you are not convinced that our program is the best for you, simply notify us within 24 hours of your first session and return your materials for a full refund.

Student Information                                                          Privacy and Security

Student Name Student Email (Optional)
Date Of Birth School Name  
Grade Level in Spring 2008   Math Class in Spring 2008  
Please describe any condition that you would like us to be aware of

Contact Information

Primary Contact Name   Contact Email  
Phone Number 1 Phone Number 2
Best time to reach you to discuss the course.
Address City  State   Zip

Correspondence is sent via email for your convenience. Check this box if you would rather receive correspondence by US mail.

   

Additional Contact Information (Optional)

We assume the second contact has the same information as the first unless specified.

Second Contact Name   Contact Email  
Phone Number 1 Phone Number 2
Address City  State   Zip

Correspondence is sent via email to the primary contact. Check this box if you would like email sent to this second contact email address as well as the primary email.

                                                                                  

Emergency Contact Information

Emergency Contact Name   Phone Number l  
Phone Number 2  

Emergency Medical and Liability Release - As a parent you recognize that there are risks associated with attending a summer class and assume responsibility for your child, holding Savvy Minds LLC harmless. Should a life threatening emergency arise and we are not able to make contact with you, we would bring your child to receive medical attention.  View Full Release   

Media Release - We use photos of student in classes in our catalogs and website. Names are not associated with such photos. If you are comfortable with this practice select yes.

How did you hear about Savvy Minds?              

Comments about how you heard?

                                                      Not Accepting Registration at this time.                 

We also accept reservations by phone (503) 442-8899, mail and fax. You may print this form and fax or mail it to:

(Fax) 503 233-6464
Savvy Minds LLC
1816 SE Lambert Street
Portland, OR 97202