Middle / Upper Sep 26, 2021 Sunday, 10:30 AM - 1:30 PM (ET) Online $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Lower Oct 17, 2021 Sunday, 9:00AM - 12:00 PM (ET) Online $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Middle / Upper Oct 17, 2021 Sunday, 9:00 AM - 12:30 PM (PT) Online $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Middle / Upper Oct 17, 2021 Sunday, 9:00 AM-12:30 PM 750 Lexington $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Lower Oct 23, 2021 Saturday, 9:30 AM - 12:30 PM (PT) Online $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Lower Oct 23, 2021 Saturday, 9:00 AM-12:00 PM 750 Lexington $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Lower Oct 23, 2021 Saturday, 9:00 AM-12:00 PM 222 Broadway $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Middle / Upper Oct 23, 2021 Saturday, 9:00 AM - 12:30 PM (ET) Online $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Middle / Upper Oct 23, 2021 Saturday, 10:00 AM - 1:30 PM (PT) Online $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Middle / Upper Oct 23, 2021 Saturday, 9:00 AM-12:30 PM 222 Broadway $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Lower Nov 14, 2021 Sunday, 9:00AM - 12:00 PM (ET) Online $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Middle / Upper Nov 14, 2021 Sunday, 9:00 AM - 12:30 PM (PT) Online $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Middle / Upper Nov 14, 2021 Sunday, 9:00 AM-12:30 PM 750 Lexington $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Lower Nov 20, 2021 Saturday, 9:30 AM - 12:30 PM (PT) Online $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Lower Nov 20, 2021 Saturday, 9:00 AM-12:00 PM 750 Lexington $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Lower Nov 20, 2021 Saturday, 9:00 AM-12:00 PM 222 Broadway $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Middle / Upper Nov 20, 2021 Saturday, 9:00 AM - 12:30 PM (ET) Online $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Middle / Upper Nov 20, 2021 Saturday, 10:00 AM - 1:30 PM (PT) Online $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Middle / Upper Nov 20, 2021 Saturday, 9:00 AM-12:30 PM 222 Broadway $160.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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Any Level Self-Administered Date & Time of your choosing At Home $160.00 $110.00 Student Information Student Name AMEX First Last Expected HS Grad Date ? Select the year that the student is expected to graduate from high school. E.G: 5th graders are expected to graduate in spring 2029, 8th graders are expected to graduate in spring 2026, 11th graders are expected to graduate in spring 2023 Please Choose Spring 2022 Spring 2023 Spring 2024 Spring 2025 Spring 2026 Spring 2027 Spring 2028 Spring 2029 Spring 2030 Spring 2031 Spring 2032 Date of Birth Current School Does the student need to wait for someone to pick him/her up after class? Yes (Student must wait for someone.) Who is authorized to pick up the student? Your student's safety is important. This authorization will let us know who your student may leave the building with after class. Unfortunately, if the person's name is not listed on this form, a parent/guardian must be contacted for permission before the student can travel. If other, please provide a complete list of persons authorized to pick up the student. Parent/Guardian Other Please provide first and last names as well as any necessary contact information. No (Student may go home alone.) Does the student have any medical concerns and/or currently take any medications? If so, please list below. Does the student have an IEP or 504 plan that provides extra time on assessments? Yes No Does the student have any learning difficulties? If so, please specify below. I wish to withdraw consent from media release. Yes No Student Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Primary Contact Information My relationship to student Mother Father Primary Contact Name Same as my billing information First Last Address Same as my billing address Street Address City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP / Postal Code Email Same as my billing information Email Phone Number Same as my billing information Phone Number Alternate Phone Number Add to cart

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