New Registration Application

Please enter the data only after you have read All Bright Center, LLC. Privacy Statement and accepted it.
Otherwise you may choose to Print Registration Form, fill it manually and send it by Mail or Fax to All Bright Center.

Fields marked with this color are required.
        Account Email:
Please make sure to enter account email address correctly.
Your registration will not be accepted until you email address is verified. When application is submitted - the verification email will be sent to this given address. That email will contain instructions for you to follow in order to complete application process.

Please be aware that registrations without confirmed email address will be ignored by the system.
Student
        First Name:
        Last Name:
Gender:
Date of Birth:
(yyyy-mm-dd):
        Home Phone:
        Email:
Residence Address:
Programs to enroll:

Note: if you choose SummerBright program please specify start and end dates
Student Parents
Parent 1:
        First Name:
        Last Name:
        Occupation:
        Daytime Phone:
        Cell Phone:
Parent 2:
        First Name:
        Last Name:
        Email:
        Occupation:
        Daytime Phone:
        Cell Phone:

Emergency Contact
(other than parents)
        Name
Phone:

  

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