Life Skills Modules Student InformationFull Name of Student: *Age: *Grade Level (6th – 10th):School Name (if applicable):Parent/Guardian InformationFull Name of Parent/Guardian: *Phone Number *Email Address *Home Address (if requesting in-home sessions):Program SelectionSelect your preferred training type (choose one): *In-Home One-on-One TrainingGroup WorkshopVirtual Program (Live Zoom)Choose the modules you’d like to enroll in: *Making Your BedLaundry SkillsCloset OrganizationDishwashing & Kitchen CleaningBasic Cooking SkillsCandle MakingPainting & ArtGardening BasicsHobbies & CraftsSelf-Care and HygienePreferred Session(s): *$50 Single Session$85 Combo Session (2 modules)$250 Full Life Skills Course (All modules)Scheduling PreferencesPreferred Days: *MondayTuesdayWednesdayThursdayFridaySaturdayPreferred Time Slot: *Morning (9am–11am)Midday (12pm–2pm)Afternoon (3pm–5pm)Evening (6pm–8pm)Emergency InformationEmergency Contact Name:Emergency Contact Number:Allergies or Medical Notes:Consent *I confirm that I have read and agree to the Terms & Conditions and Parent Consent Agreement.I give permission for my child’s photos/videos to be used for Skills Connect Academy marketing purposes.I understand that all payments must be made prior to the start of class sessions.Parent/Guardian Signature:Choose FileNo file chosenDelete uploaded fileDate:Submit
