Student Name *

Parent Name (If Different)

Who are you referring *

Referral Phone Number *

Referral Email

Age of Referral if it is a Child

How do you know this person

Referral Bonus *

By checking this box, I consent to receive non-marketing text messages from [BUSINESS NAME] about [USE_CASE_FROM_CAMPAIGN_DESCRIPTION]. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others, from [BUSINESS NAME] at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

I understand that the rewards will be given 2 calendar months after the new student starts. For example if they start in June the reward will be in August *

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