Gap Registration Form

Registration is limited. Once you complete the form, a Westcoast Connection representative will be in touch with you to answer any questions you may have.

For Program Descriptions Click Here
Participant Information
Participant Name: *




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Parent/Guardian Information


Parent/Guardian 1 Name: *




Parent/Guardian 2 Name:



Home Address












Program Selection

Billing Information
I agree to pay my deposit of $1,500.00 by credit card or EFT within 48 hours of being invoiced. I agree to pay the balance in full by check, money order or electronic transfer only by December 1st, 2020. For enrollment after December 1st, the balance is due by check, money order or electronic transfer within 7 days of enrollment. (All payments are in U.S. Dollars.)  

Other Billing Contact




Billing Address












By selecting No Additional Signature Required in the drop down below, I agree to this statement: I am the parent or authorized legal guardian of PARTICIPANT and confirm I have the authority to execute this Application, and I do execute it on my own behalf, on behalf of any other parent, guardian or legal representative and on behalf of the PARTICIPANT. I confirm that no additional signature is required by another parent, guardian or legal representative of PARTICIPANT and will hold WCC harmless for any costs resulting from this being untrue.
By selecting Additional Signature Required in the drop down below, I agree to this statement: I am the parent or authorized legal guardian of PARTICIPANT. I execute this Application, on my own behalf. An additional signature is required by another parent, guardian or legal representative of PARTICIPANT.


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