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The Confident Learning Lab

Guided Learning + Music + Fun
for Unusual Times.

Session runs Feb. 1 - April 8

Monday - Friday 8am to 3pm

After you submit the registration form below, you will be redirected to
finalize your enrollment with your deposit and scheduling your meet and greet.

Student First Name

Student Last Name

Student Date of Birth

Student School

Student Grade

Does the student have any allergies or medical conditions? Please list them. *

Does the student have any learning differences, have an IEP, or need any accommodations? *

Parent/Guardian First Name

Parent /Guardian Last Name

Parent Email *

Best Phone Number*

Emergency Contacts Name and Phone* (please list two)

I understand my Confident Learning Lab Deposit is refundable and will be applied to my first month or the term balance after an in-person meet and greet (if my child is not Lab alumni) .*

I understand that tuition reserves my child's place in the lab, whether they attend or not. I understand that while I may invest in the program with installments, I am enrolling them for the entire quarter.

I understand drop off time is 8am. I will send my child to the door as we are trying to limit contact with others. Pick up time is between 1pm-3pm and I understand my child will be sent out to me.*

I understand that if tuition is late a $40 late fee will be applied to my account. I understand the Lab is closed for all Portland Public School no school days. *

I understand I must provide peanut-free snacks and lunch for my child each day. I also must send assignments/packets, including all instructions from the teacher if there are any. *

I understand temperatures will be taken at the door. If my child has a temperature, they will be sent home. Masks are required to enter the building. *

I understand daily outdoor time is weather permitting. *

I understand the Lab may take videos and photos of students to inspire others in our community. Their name will never be used. *

I will communicate school schedule, assignment info, and any other information about my child so the Lab team can be the best resource for my child as possible. We are in partnership and I will respond to messages so the lab team knows I received them. I know that no one can read my mind and I will be forthcoming with information and feedback.

Please select your Confident Learning Lab Tuition Installment Plan *

What is your preferred start date for the Learning Lab? (if you're joining after Feb 1) We will confirm by phone or text.

I'd like information about a partial scholarship.

I won't be billed for tuition (except the deposit) until after an in-person meet and greet and until I accept the scholarship offer.

If I decline the scholarship, my deposit will be refunded to me.

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Anything else we should know?

Billing Details:

Name On Card

Card Number

Expiration Month

Expiration Year

CVC

Billing Address

Billing Address 2

Billing City

Billing State

Billing Country

Billing Zipcode

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