Private Lesson Registration

Registration Form

Child First Name *

Child Last Name *

Child's Grade at Time of Class *

Gender

Parent First Name *

Parent Last Name *

Parent Email *

Confirm Parent Email *

Parent Phone Number *

City

Zip

Address

Instructor *

Schedule ({{ tz }})*

no schedule

Topic *

Notes

Parent Name

Parent Email

Child Name

Session

Total

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Coupon ({{ couponCode }})

-${{ discount.toLocaleString(undefined, { minimumFractionDigits: 2 }) }}

Amount Due

${{ amountDue.toLocaleString(undefined, { minimumFractionDigits: 2 }) }}

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Payment Details

Card Number

Card Expiry

CVC

Zipcode

I am authorizing Coder Kids to automatically make charges for future lessons to my credit card without reviewing the invoice. Lessons will be charged as they are logged by the instructor. You will continue to receive payment receipts. Please contact us if you see any error in billing.

I agree to the terms of the Liability Waiver *

I agree to the terms of the Refund and Behavior Policy *

Private Lessons

Registration Form

Payment Details

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