CONTACT INFORMATION
Name (required):
Age (required):
Gender (required): —Please choose an option—MaleFemale
Street Address (required):
City (required):
State (required):
Zip/Pin (required):
Phone (required):
Email (required):
PARENTS INFORMATION
Father’s Name (required):
Father’s Phone (required):
Mother’s Name (required):
Mother’s Phone (required):
ALLERGIES/MEDICAL CONDITIONS (required):
MEDICATIONS (required):
MEMBERSHIP INFORMATION
Fees: £120 per Year £40 per Quarter £15 per month We provide a one off payment option and an option to pay in installments
This fee entitles your child to:
• Monthly Tween/Teen Group Coaching via Webinars • Free 'Affirmation 4 Tweens & Teens EBook' • Free E copies of our Termly Magazine • Daily Tween/Teen Truth quotes sent via our WhatsApp group • Visit to corporate offices/museums
And many more....
Date (required):
Parents Signature (required):
Tween/Teen Signature (required):
[recaptcha]
By using this form you agree with the storage and handling of your data by this website.
Δ
Username
Password
Captcha *
Remember Me
Username or Email