IA SignUp Form

Name:

Class Type:

Session Type:

Class Session:

Age:

High School Grade:

Telephone:

Parent's Name:

Parent's Email Address:

Parent's Home Phone Number:

Parent's Work Phone Number:

Address:

City:

State:

Zip:

Email:

Email (confirm):

Does the student have an account with us? YesNo

**We highly recommend you submit an application for an account before the first session of our course. All accounts will be open after the first week of class. You can apply online, over the phone or in our branch. For more information call (818) 846-1710.**

Where did you hear about the program?

Student Sign-Up