Parent/Guardian 1 Name *

First Name

Last Name

Parent/Guardian 2 Name

First Name

Last Name

Student Name *

If registering more than one student, please submit a separate form for each.

First Name

Last Name

Student Birth Date *

MM

DD

YYYY

Phone 1 *

(###)

###

####

Phone 2

(###)

###

####

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I would like my student to attend USASB Unschool Academy of Art, Science, and Business *

Yes

I understand USASB is a year-round, private learning environment and will require tuition of $8,340 per year ($695 per month). *

The USASB Unschool Academy of Art, Science, and Business, Inc. admits students of any race, color, national, and ethnic origin to all the rights, privileges, programs, and activities generally accorded or made available to students at the school. It does not discriminate on the basis of race, color, national and ethnic origin in administration of its educational policies, admissions policies, scholarship and loan programs, and athletic and other school-administered programs.

Yes