E-Learning Registration Student Name* First Last Parent Name* First Last Email* Home Phone*Cell PhoneAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I would like to suggest the following Teacher Talk date and time.What are the strengths and needs of your child academically and socially?Can I use pictures of your child in class for promotional purposes?*YesNoCOPYRIGHT LICENSE AGREEMENT* I Agree By checking the “I Agree” button, I understand that I am agreeing that Early Education Enrichment (EEE) has developed an original compilation of teaching/tutoring materials designed for use with four-year old pre-school and kindergarten aged children. EEE claims all videos and written materials as original Copyrighted Work. I understand that I am given the non-transferable rights to use these materials for personal use; however, I do not have permission to copy any written materials or videos to share with others. These materials are for my personal use only. Cindy Venckus Early Education Enrichment LLC 5201 Cumnor Road Downers Grove, IL 60515 630-975-5282 email@example.com www.EarlyEducationEnrichment.comPhoneThis field is for validation purposes and should be left unchanged.