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Genesis Reading Center Application
3901 Williams Blvd. Suite 8 Kenner, LA 70065 504-463-5756 email: debbie@genesisread.com
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Student’s Name Male or Female Today's Date: |
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Age Date of Birth Last Grade Completed
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Last School Attended School Attending During Next School Term |
Street address City Zip code
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email address |
Names of Parents or Guardians Mother _________________ Occupation ___________ Work Place ______________ Father __________________ Occupation ___________ Work Place ______________ |
Mother's phone numbers: Father's phone numbers: Home- Home- Work- Work- Cell- Cell- |
Emergency Contact- Phone- Relationship- |
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I wish to enroll in: |
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How did you hear about us? Telephone Book Kids Directory Sign Referred by______________________ Other __________________ |
| Registration fee of $50.00 must accompany this application. Fee is nonrefundable unless session is cancelled. Tuition for classes and private tutoring must be paid in full prior to the first scheduled class (no exceptions). |
Kenner Location
3901 Williams Blvd. Suite 8
Kenner, LA 70065
Phone: 504.463.5756
Cell: 504.400.5756
email: debbie@genesisread.com