THE STORY SCHOOL MEMBERSHIP CONTRACT

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Last Name *

First Name *

M.I.

Registration Date * +

Age Check for Person Responsible for Billing
Attest to birthdate or at least month and year of birth
MM/YY or MM/DD/YYYY format
*

Student's Name (if different from above)

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

E-mail Address *

Optional Birthdate / Age of Student
If comfortable, provide the birthdate of the student (MM/DD/YYY)
Otherwise only include the current age of the student
*