Website Enrollment Form

Parent Name (First, Last)

Parent Email

*This is how you will receive invoices from CLC

Parent Phone

Student First Name *

Student Last Name *

Student Phone

Student Email

Address Line 1

Address Line 2

City

State/Province

Zip/Postal Code

Country

Preferred Method of Contact

Call

Email

Mobile

Text

Other

Student Grade

Tutoring Subjects/Needs

IEP or 504 Plan

Academic Information

Is there anything else you would like us to know about your student's academics?

School Name

Does your family qualify for free or reduced lunch?

Yes

No

Prefer Not to Disclose

How did you hear about us?

BGV Student Discount

Are you or a close family member employed by Breck Grand Vacations? Proof required: pay stub or manager letter

Data Privacy & Consent

Yes, I would like to receive text messages from Colorado Learning Connections.

OPTIONAL: Create an account to save your information and access our online portal!

Login Name

Password

Retype Password