EyeconTECH Student Based Quiz Registration Form

Student Information

Full Name: Date of Birth: Grade/Year Level: School Name: School Address: City: State/Province: (Optional) Postal Code: (Optional) Email Address: Phone Number:

Parent/Guardian Information

Full Name: Relationship to Student: Email Address: (Optional) Phone Number:

Registration Fee Payment

Please indicate your method of payment:

Rgistration fee = GHC 20.00
Procesing fee = GHC 2.00
s Other Charges = GHC 3.00
Amount Payable: GHC 25.00
Mobile Money (Please specify): Cash (Please submit payment to the school office)
Bank Transfer (Account details will be provided upon submission of this form)

Consent

I confirm that all the information provided is accurate:
Parent/Guardian Consent: