Your E-mail address:
If the student has his own e-mail address, be sure to give your e-mail address here and not the student's.
What kind of Internet connection do you have?
Broadband (cable, dsl, fiber)
Where did you find out about the classes here?
Check the course(s) you want to use:
Number of children taking Creative Writing:
Amount due for the first half of the year: $.00 Half price:
Amount due for the full year: $.00 Half price:
Money Order payable to Richard Kephart.
Amount being paid for the classes that start in September: $.00
Payment is due when this form is sent.
Make sure you do not send this form more than once.
Write to me at if you have any trouble with this form.