Teens Intuition Class Enrollment Form

Please note: this is a 2-page form (page 2 contains the Release and Agreement to Participate). If you wish to modify an answer on the first page, do NOT reload the page in your browser, as that will clear the contents of the form. Instead use the ‘Previous’ button at the bottom of the page.

This class takes place at the Academy of Intuition Medicine® in Sausalito, California, and online via Zoom.

Teens Intuition Class Enrollment

Parent & Student information

First name of parent *

Last name of parent *

Email address *

Primary phone *

Name of child *

Age of child *

Name of 2nd child (sibling)

Age of child

Address *

Address

City

State/Province

Zip/Postal

Teens Intuition Class (Ages 11 to 16 years old)

Four-Week Course (dates on program & registration page)

(In-Person) Teen Intuition Class tuition $415*

(Zoom) Teen Intuition Class tuition $415*

(Hybrid) Teen Intuition Class tuition $415*

(In-Person) Teen Intuition Class (sibling 10% discount) tuition $373*

(Zoom) Teen Intuition Class (sibling 10% discount) tuition $373*

(Hybrid) Teen Intuition Class (sibling 10% discount) tuition $373*

(In-Person) 50% discount Repeater tuition $206*

(Zoom) 50% discount Repeater tuition $206*

(Hybrid) 50% discount Repeater tuition $206*

To complete enrollment, a parent is required to read and sign the Release and Agreement to Participate (on the next page).

*All tuition includes small PayPal transaction fee • Hybrid means that the student will attend a combination of ‘In-Person’ and ‘Zoom’ for this course.

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