Student Enrollment Form

 

* Please enter all enrollment information first, then print out form and mail to address at bottom of page *

You may have your own choice of any two consecutive days or more that you or your team may wish to attend CueSport College. This request is subject to receiving a pool school enrollment form and deposit from each student two weeks before attending ... Thank You!

 

First Name Last Name
Birth Date Male Female
Address

City State Zip

Home Phone Cell Phone Pager
Work Phone Fax
E-Mail Address Web Address
Today's Date
Dates Requested in attending CueSport College to

 

Sports/Disciplines/Activities you enjoy:

Current Expertise of Sports/Disciplines/Activities:

Expertise you wish to obtain:

Past Instructors:

History of Self-Teaching Methods:

I feel my strong points are:

I feel my weak points are:

I am enrolling because...

Preference of Staff Instructors ...

 

 

* Please expect our follow up e-mail and/or telephone call to you for confirmation of us receiving your enrollment form *

 

Credit Cards Accepted:

Name on Credit Card

Credit Card Number:

Expiration Date:

Amount to be Charged:

 

Signature:

 

 

 

A $50 deposit is required to reserve dates of enrollment to be refunded at time of arrival

* Please enter all enrollment information first, then print out form and mail to address at bottom of page *

CueSport College International

325 S. Bellevue Ave.

Peoria, IL 61604

(309) 697-2774

 

 

 
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