SSR 3/28/2019
FKCC CONTINUING EDUCATION & WORKFORCE COURSE REGISTRATION FORM
Registration after the first week of class may require written permission from the instructor. Full payment is due immediately.
Name: Student ID
Number:
_____________________________________________________________________________________________________________
Last First Middle
A (Add)
D (Drop)
Course
Prefix
Course
#
CRN
Title
Days
Time
By registering for courses, I understand and agree that I am registering for courses and am responsible for the payment of all tuition and fees by the established due dates on
academic calendar, unless I drop the courses during the refund period. If my account becomes delinquent, I will be responsible for paying the College all past due amounts/service
charges and any associated collection agency fees up to a maximum of 30% of the account balance, reasonable attorneys’ fees, cost and expenses incurred by the College in its
collection efforts. I agree to give FKCC and its agent’s permission to contact me on my home or mobile phone, email address, and mailing address. By signing below, I am entering
into a legal and binding contract with Florida Keys Community College and I hereby acknowledge that I have read and understand the Terms and Conditions of this registration
agreement and Student Financial Responsibilities policy located in Student Catalog.
Student’s Signature
Date
Instructor’s Signature (if applicable)
Date
COMMENTS FOR OFFICE USE ONLY:
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signature
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signature
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