Testing Registration Form

Parent's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PLEASE DOUBLE CHECK YOUR EMAIL ADDRESS

Your confirmation will be sent to this address from Kitty@SlusserLife.com
E-mail*
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Child One

First NameLast Name
Child One Birthdate

MonthDayYear
C1 Testing at Grade Level
Child 1: Test - Site - Date
Child One Testing Site
Child One Test Date

MonthDayYear
Child One Test Selection
Child Two

First NameLast Name
Child Two Birthdate

MonthDayYear
C2 Testing at Grade Level
Child 2: Test - Site - Date
Child Two Testing Site
Child Two Test Date

MonthDayYear
Child Two Test Selection
Child Three

First NameLast Name
Child Three Birthdate

MonthDayYear
C3 Testing at Grade Level
Child 3: Test - Site - Date
Child Three Testing Site
Child Three Test Date

MonthDayYear
Child Three Test Selection
Child Four

First NameLast Name
Child Four Birthdate

MonthDayYear
C4 Testing Grade Level
Child 4: Test - Site - Date
C4 Testing at Grade Level
Child Four Testing Site
Child Four Test Date

MonthDayYear
Child Four Test Selection
Child Five

First NameLast Name
Child Five Birth Date

MonthDayYear
C5 Testing Grade Level
Child 5: Test - Site - Date
Child Five Testing Site
Child Five Test Date

MonthDayYear
Child Five Test Selection
Child Six

First NameLast Name
Child Six Birth Date

MonthDayYear
C6 Testing Grade Level
Child 6: Test - Site - Date
Child Six Testing Site
Child Six Test Date

MonthDayYear
Child Six Test Selection
Additional Comments:
Payment Method
PREPAY OPTION VIA PAYPAL ONLY

Only use the next section if you are paying with PayPal or credit card now.

If you plan to pay by cash, check, Venmo, or ZELLE skip this payment section.

IF YOU SKIP THE PAYMENT OPTION (click no payment boxes)

CLICK "SUBMIT" below the payment section to send this form.

Note:

For ZELLE, use my mobile phone number: 352-255-1181

For VENMO, use @kitty-slusser

Or, use the QR codes on the register/pay page.
Pre-Pay Options
prevnext( X )
ITBS-Form E (Plus BJU Fee)$50.00
Test must be ordered from BJU

Quantity

CAT-5 SURVEY (GRADES 1-12)$50.00
Group Testing

Quantity

Portfolio Review$50.00
In Person or Virtual

Quantity

PIAT$75.00
Must be in person.

Quantity

Total $0.00
Name

First NameLast Name
Should be Empty: