SSL Class Registration 2023 SSL Class Registration 2023 Please provide your contact information to register for class Click here to make your payment of $75. Your payment is due with this form to finalize your class registration and reserve your spot in the class. ¡Tantas gracias!Student Name(Required) First Last Level(Required) Do you prefer morning or evening classes?(Required) Age(Required) Phone Number(Required)Contact methods(Required) Phone Call Text Message Email Choose all that you useText Notifications(Required) Yes No Do you accept text messages from Roosevelt Park Ministries used for classes/event updates for our students/members? Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email(Required) What do you do /is your profession?(Required) Emergency contact name(Required) First Last Emergency contact phone number(Required)Relationship(Required) While attending the class, will you need child care?(Required) Yes No How many children?(Required)Child's name(Required) First Last Age(Required) Child's name First Last Age Child's name First Last Age Child's name First Last Age What is your nationality / race / ethnicity?(Required) What is your family's annual income?(Required) Less than $15k $15k - 24k $25k - 34k $35k - 49k $50k - 74k $75k - 99k $100k - 149k $150k - 200k More than $200k How many people are in your household (family)?(Required) If you do not work, use the income of the person who supports you. This information will not be disclosed to any government institution or associates.Check here if you give us permission to have photos taken of you and used in any social media platforms and website, public relations material, or publications that may be affiliated with Roosevelt Park Ministries including, but not limited to newsletters.(Required) Yes No How did you hear about us?(Required) Please read the Roosevelt Park Ministries Class Terms. Click to view PDF.I have read and understand the class etiquette and protocol and I understand the Class Terms of Roosevelt Park Ministries.(Required) Yes Print Name(Required) Date(Required) MM slash DD slash YYYY Your payment of $75 is due with this form to finalize your class registration and reserve your spot in the class. ¡Tantas gracias!
