Group Enrolment Form for Courses
1. Student enrolment information
A. Student course selection
  Surname First Name Age Group Birth Date Gender Course Start Time
B. Total number of courses ordered:  
2. Mailing Address:
3. Phone Number:
4. Email Address:
5. Supervisor Name (if applicable):
6. Supervisor phone number (if applicable):
7. Supervisor email address (if applicable):
8. Supervisor relationship to student (if applicable): ParentTeacherOther
9. From which environment will you be learning English?
From a school - What is the name of your school?
From a business - What is the name of your business?
10. Payment
Please use the following table to determine the total program cost for the class(es) which you have chosen for this trimester.
Total Number of Courses
Ordered (from 1.B)		   Cost Per Course Sub-Total
0 X $275 $0
Registration Fee ($25 per student, maximum $100) $0
TOTAL PROGRAM COST $0
Billing Information
Enter your credit card information:
Name on card:
Card Type:
Card Number:
Expiration Date:   
Card Security Code:   What is this?
As a security measure, your credit card will NOT be charged automatically when you submit this registration. A member of the Red Rock ELC staff will manually charge your credit card for the cost when he/she receives your registration.
Thank you for completing this application. Click on the "Submit" button below to send your application information to the director of the Red Rock English Language Centre.