Students Name	Birth Date (mm-dd-yyyy)	Age
	-  -
Address	Zipcode	Phone
School	Grade	Gender
	------------ First Second Third Fourth Fifth Sixth Seventh Eighth Nineth Tenth Eleventh Twelveth	------------ Male Female

If I had to describe my child in one word, it would be
My child is most interested in...	My child's Favorite subject in school is...
Music Art Sports Dance Drama Socializing	Math Science Social Studies Reading Physical Education Music Art Foreign Languages Computers

Parents Name	Email Address
Address	Zipcode
Work Phone	Mobile Phone

I believe that my child is performing _____ his/her potential.	I am most interested in...
Below At Above	Increasing my child's Academic Performance Increasing my child's motivation and/or desire to learn Advanced Skill Development Nurturing my child's skills, talents, and abilities

I would like to learn more about the following Hive Five© programs:

After-school Achievers©   B.U.G. Tutoring© Bringing Up Grades   S.A.P.© Summer Achievement Program   W.A.S.P © Supplemental Instruction Program   B.E.E.T.L.E © Youth Empowerment Series

The best way to contact me is:

Home Phone Mobile Phone Email Direct Mail

The Best time to contact me is:

Morning Afternoon Evening

Congratulations! You've taken the first steps to achievement for your child. The next step is to come and see The B.E.E. Academy© and our Colony at work. If you would like to schedule an appointment to visit The B.E.E. Academy® and speak with a Colony Coach© select your availablity below.
The Best day for me to visit is:
(click here)
The Best time for me to visit is:
7:00-9:00 am 11:00 am-12:30 pm 2:00-4:00 pm 5:00-7:30pm