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Florida-Registration
Moshe Gotfryd
2022-08-02T07:12:01-04:00
Maxi Mind Florida Registration Form
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*
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Student Name
*
First
Last
Parent Name
*
Primary Email
*
This email address should match the primary email on all your Maxi Mind forms
Phone
*
Please Read the Fine Print
*
I would like to register my child for a semester of Maxi Mind Learning. I understand and accept the following policies:
The registration deposit of $500 is non-refundable and it reserves my child’s priority scheduling for Maxi Mind services in the coming school year. It also prepays my child’s first 4 brain training sessions.
After determining the target number of sessions, Maxi Mind will charge my credit card monthly for scheduled future sessions, with the last payment being about a month before the scheduled end of the Maxi Mind course.
Maxi Mind will try to make up any sessions my child missed due to illness or if notified a day or more in advance. Skipped or short notice cancellations may be charged at half the hourly rate at Maxi Mind’s sole discretion. I may cancel the Maxi Mind course without penalty, with at least two weeks’ notice.
Following course completion or cancellation, any funds on deposit against sessions which did not occur, will be refunded as per the above policies.
I understand that Maxi Mind is not affiliated with Cheder Chabad, LEC, or LHA. Maxi Mind is an independent organization providing services at these premises.
Client confidentiality is strictly maintained, with the caveat that the child’s coach and the case management team may have access to client files to the extent required by their role.
I have read and agree to the terms and conditions above.
Skip Online Payment
I will give credit card information over the phone
Registration Deposit
Price:
During the course, Maxi Mind will charge my credit card monthly for scheduled future sessions with the last payment being about a month before the end of scheduled sessions.
Credit Card
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Month
Month
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02
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Year
Year
2024
2025
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2033
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Security Code
Cardholder Name
Email
This field is for validation purposes and should be left unchanged.
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