Name of Student *

First Name

Last Name

Desired License Type *

Please select only one!

Single Use License

Multi-Use License

TOR Name *

Please provide the name of the parent/guardian who will be acting as the Teacher of Record (TOR) for this student.

First Name

Last Name

Contact Preference

If the TOR would rather be contacted primarily via text rather than email, please check the box below and provide your phone number.

Please contact me via text rather than email

TOR Phone Number

(###)

###

####

Additional Parent/Guardian

If desired, we can create a parent account which will allow a second parent/guardian to view the student's progress.

First Name

Last Name