Distance Learning Classes – Windtree Education

Grades 1-4

Grades 5-8

Please fill out application form below to receive dates and times for upcoming virtual classes.

Distance Learning Registration

Step 1 of 3 - SECTION I (Student Information)

SECTION I. STUDENT CONTACT INFORMATION
Student Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Age*
Gender*
- Male
- Female
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
CURRENT Grade Level*
School*
Email*

SECTION II. PARENT/ GUARDIAN INFORMATION
Parent / Guardian Name*
First Last
Relationship*
Your relation to the student
Contact Number*
Home number / Mobile number
Email*
How did you hear about Windtree Education?*
- Enrolled in classes before
- Internet search
- School administrator
- Social media
Which school/program did you enroll?*

SECTION III. SIGNATURES AND CONFIRMATION
I hereby fully affirm that the information provided on this application is complete and true.

I agree to receive information about upcoming distance learning classes from Windtree Education.
Applicant Signature*
Date*
Date Format: MM slash DD slash YYYY
Parent or Guardian Signature*
Date*
Date Format: MM slash DD slash YYYY