Registration | Alternative Learning | American Canyon

top of page

707.353.5595

Home
Book Online
12 Modes of Learning
1:1 Instruction
Assessments
IEP Support
Contact
Our Team
Plans & Pricing
More

Use tab to navigate through the menu items.

Registration

To register your child, please take the time to fill out the following information.

First Name of Child

Last Name of Child

Email

Phone

Birthday

Address

School

Grade

Teacher

Primary Contact in case of emergency, or if a session has to be cancelled

Mother's First Name

Mother's Last Name

Email

Phone

Occupation

Father's First Name

Father's Last Name

Email

Phone

Occupation

Siblings' Names & Ages

bottom of page