Whiz Kid Academy – Enrollment Form

Select your enrollment track:

Select your curriculum enhancements (recommended):

Parent First Name:

Parent Last Name:

Child First Name:

Child Last Name:

Child Date of Birth:

Email:

Mailing Street Address

Address Line 2:

City:

State:

Postal / Zip Code

How did you hear about us?

Phone:

Choose Login Password:

Confirm Password

*Whiz Kid Academy does not share or sell customer information.

**Enrollment is not complete until “Enroll Now” button is clicked on next page. Credit card required, but not charged during 7-day trial.