Enrollment Agreement
for Distance Education Students
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Instructions
: There are 4 pages to this agreement. Please fill out the agreement completely. ALL fields are required and must be filled in before the agreement can be submitted. If there is more than one child in the family enrolling, please list the oldest first. To submit the agreement, click on the "Submit Agreement" button on the last page, otherwise all the information you entered will be lost. If you have any questions, contact Liahona at 801-785-7850.
Student and Parent Information
Student Last Name
First
Middle
Date of Birth
(mm/dd/yyyy)
Male
Female Select the grade the student will be in for 2008/09
6
7
8
9
10
11
12
New Enrollment
Re-Enrollment If in 12th grade, does this student plan to graduate this year
NA
Yes
No
Father's Name
Occupation
Mother's Name
Occupation
Address
City
State
Zipcode
Country
Home Phone
Father's Cell
Mother's Cell
Parent E-mail Address
How did you hear about Liahona Distance Education?
Additional Children Enrollment
Instructions
: If you wish to enroll more than one child from the same family, select the number of additional children and then enter the information for each child.
Select the number of additional children to enroll
0
1
2
3
4
5
6
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