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Got Questions? Call us at 646-883-0123
REGISTRATION FORM -
ON
LINE DEBATE PROGRAM
1. Student Information
Student's Name
*
First
Last
Date of Birth (mm/dd/yr)
*
Grade
*
5
6
7
8
9
10
11
12
Debate Experience
*
Years of Experience
0
1
2
3+
School Name
*
City, State
*
Student's Email
*
2nd Student's Name
*
First
Last
Date of Birth (mm/dd/yr)
*
Grade (2016-2017)
*
Debate Experience
*
3rd Student's Name
*
First
Last
Date of Birth (mm/dd/yr)
*
Grade (2016-2017)
*
Debate Experience
*
2. Contact Information
Parent's Name
*
First
Last
Phone Number
*
Email
*
Home Address
*
City
*
State
*
Zip Code
*
3. Online Debate Program Schedule
1. Intro Package for New Students ($165)
*
Four 90 Minute Online Sessions
Tuesdays (5:30-7:00) - $165
Thursdays (5:30-7:00) - $165
2. Private Debate Coaching
*
Format of Debate
Public Forum ($60/hour)
Lincoln Douglas ($60/hour)
Policy ($60/hour)
4. Payment Information
All payments are
Non-Refundable
.
Credit will be provided up to 1 year from the date of the event.
Option 1: Pay By Credit Card
Please fill out the credit card information below:
Name on Card
*
Card Number
*
Expiry Date (MM/YR)
*
Security Code
*
3 digits on the back or 4 digits in the front for AMEX
Zip/Postal Code
*
Option 2: Pay By Check
If you are paying by check, please make the check payable to "AGAPE"
Address:
1333A North Ave, Suite #534
New Rochelle, NY 10804
By submitting this registration form, I hereby give permission for my child to participate in the above indicated program. I am also indicating my agreement to all terms and conditions of enrollment listed on this website, in particular, that tuition deposits and payments are non-refundable.
REGISTER
✕
