Registration & Enrollment Free Consultation First Name Last Name Email Phone Child Grade Level Select grade Pre-K Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Other Reason for consultation: Micro school Assesement Tutoring Message Submit Secure Family Registration Family Registration Complete the parent/guardian and child information below, then continue to Clover’s secure checkout. The fee is $150 per child and is non-refundable. $150 per child · Maximum 4 children Website 1 Parent / Guardian InformationPrimary contact details for this registration. Parent / Guardian #1 First Name * Last Name * Parent / Guardian #2 (optional) First Name (optional) Last Name (optional) Email Address * Phone Number * Address * 2 Child InformationAdd up to four children. Each child adds $150 to the non-refundable registration total. Privacy notice: Social Security numbers are encrypted before storage and are never included in email notifications. Child 1 Student Information Student First Name * Student Last Name * SSN Number * Encrypted before it is saved. Date of Birth * Gender * Select gender Female Male Non-binary Other Prefer not to say Child's Grade * Select grade Pre-K Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Other Unique Ability (if applicable) ADD/ADHD Dyslexia Custom Please specify Child 2 Student Information Remove Student First Name * Student Last Name * SSN Number * Encrypted before it is saved. Date of Birth * Gender * Select gender Female Male Non-binary Other Prefer not to say Child's Grade * Select grade Pre-K Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Other Unique Ability (if applicable) ADD/ADHD Dyslexia Custom Please specify Child 3 Student Information Remove Student First Name * Student Last Name * SSN Number * Encrypted before it is saved. Date of Birth * Gender * Select gender Female Male Non-binary Other Prefer not to say Child's Grade * Select grade Pre-K Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Other Unique Ability (if applicable) ADD/ADHD Dyslexia Custom Please specify Child 4 Student Information Remove Student First Name * Student Last Name * SSN Number * Encrypted before it is saved. Date of Birth * Gender * Select gender Female Male Non-binary Other Prefer not to say Child's Grade * Select grade Pre-K Kindergarten Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Other Unique Ability (if applicable) ADD/ADHD Dyslexia Custom Please specify + Add Another Child Maximum 4 children Non-Refundable Registration Total $150.00 USD 1 child × $150.00 ✓ Secure Clover Checkout I confirm that the information provided is accurate and understand that the registration fee is $150 per child and non-refundable. Continue to Secure Payment $150 Card details are entered on Clover’s secure hosted checkout page and are never stored on this website.