Online Registration/Payment Form

Online Testing Registration

Parent Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Testing Location(Required)

Enter the location where you will be testing. Pricing and Date are location-dependent.

This field is hidden when viewing the form

Testing Location Hidden(Required)

Hampton Roads & NE North Carolina

Richmond, Virginia

Northern Virginia

Waynesboro, Virginia

Charles Town, West Virginia

Hawaii

Enter the location where you will be testing. Pricing and Date are location-dependent.

Date you want your child tested (Hampton Roads & NE North Carolina)

Pricing is based on the month you choose. Lowest rates are March – July. Actual date will depend on availability of proctors – you will be contacted to schedule a date that works for your family.

Date you want your child tested (Waynesboro)

Actual date will depend on travel arrangements – you will be contacted to schedule a date that works for your family.

Date you want your child tested (Northern Virginia)

Actual date will depend on travel arrangements – you will be contacted to schedule a date that works for your family.

Date you want your child tested (Richmond)

Actual date will depend on travel arrangements – you will be contacted to schedule a date that works for your family.

Date you want your child tested (Charles Town WV)

Actual date will depend on travel arrangements – you will be contacted to schedule a date that works for your family.

Date you want your child tested (Hawaii)

Actual date will depend on travel arrangements – you will be contacted to schedule a date that works for your family.

This field is hidden when viewing the form

Date you want your child tested (San Diego CA)

Actual date will depend on travel arrangements – you will be contacted to schedule a date that works for your family.

Child Information

Child’s Name	Test Group	Actions

There are no Entries.

Total

Price: $0.00

Comments

Please let us know anything that will help make your child(ren)’s testing experience exceptional

Credit Card Payment

Stripe Payments

Online Testing Registration

Parent Name(Required)

First Last

Email(Required)

Enter Email Confirm Email

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Testing Location(Required)

Enter the location where you will be testing. Pricing and Date are location-dependent.

This field is hidden when viewing the form

Testing Location Hidden(Required)

Hampton Roads & NE North Carolina

Richmond, Virginia

Northern Virginia

Waynesboro, Virginia

Charles Town, West Virginia

Hawaii

Enter the location where you will be testing. Pricing and Date are location-dependent.

Date you want your child tested (Hampton Roads & NE North Carolina)

Pricing is based on the month you choose. Lowest rates are March – July. Actual date will depend on availability of proctors – you will be contacted to schedule a date that works for your family.

Date you want your child tested (Waynesboro)

Actual date will depend on travel arrangements – you will be contacted to schedule a date that works for your family.

Date you want your child tested (Northern Virginia)

Actual date will depend on travel arrangements – you will be contacted to schedule a date that works for your family.

Date you want your child tested (Richmond)

Actual date will depend on travel arrangements – you will be contacted to schedule a date that works for your family.

Date you want your child tested (Charles Town WV)

Actual date will depend on travel arrangements – you will be contacted to schedule a date that works for your family.

Date you want your child tested (Hawaii)

Actual date will depend on travel arrangements – you will be contacted to schedule a date that works for your family.

This field is hidden when viewing the form

Date you want your child tested (San Diego CA)

Actual date will depend on travel arrangements – you will be contacted to schedule a date that works for your family.

Child Information

Child’s Name	Test Group	Actions

There are no Entries.

Total

Price: $0.00

Comments

Please let us know anything that will help make your child(ren)’s testing experience exceptional

Credit Card Payment

Stripe Payments