Language
English (US)
Kumon of Crofton - Enrollment Questionaire
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Parent Information
Parent/Guardian Name
*
First Name
Last Name
Relationship to Student
Mother
Father
Other
Phone Number
*
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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General/Referal Information:
What prompted you to call?
*
How did you hear about Kumon?
*
Drive by
Online
Word of mouth
Other
Were you referred?
*
Yes
No
If 'Yes', who referred you?
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Student(s) Information
Student 1
*
First Name
Last Name
Birth Date
*
January
February
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Year
Grade
*
School Name
*
Please Select
Crofton ES
Crofton Meadows ES
Crofton Woods ES
Nantucket ES
Piney Orchard ES
Four Seasons ES
SOTI
Crofton Middle
Central Middle
AACPS ES Other
AACPS Middle Other
PGCPS ES Other
Private
Public Other
Other
What academic goals do you have for your child(ren)?
*
Subjects
*
Math
Reading
Both
Tutoring
Other
Instruction Preference Type:
*
Online
In Person
Preferred Day:
*
Monday
Tuesday
Wednesday
Thursday
Saturday *Levels A and above only
Preferred Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
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59
Minutes
PM
AM/PM Option
Until
until
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
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59
Minutes
PM
AM/PM Option
Student 2
First Name
Last Name
Birth Date
January
February
March
April
May
June
July
August
September
October
November
December
Month
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Grade
School Name
Please Select
Crofton ES
Crofton Meadows ES
Crofton Woods ES
Nantucket ES
Piney Orchard ES
Four Seasons ES
SOTI
Crofton Middle
Central Middle
AACPS ES Other
AACPS Middle Other
PGCPS ES Other
Private
Public Other
Other
What academic goals do you have for your child(ren)?
Subjects
Math
Reading
Both
Instruction Preference Type:
Online
In Person
Preferred Day:
Monday
Wednesday
Thursday
Preferred Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
30
Minutes
PM
AM/PM Option
Student 3
First Name
Last Name
Birth Date
January
February
March
April
May
June
July
August
September
October
November
December
Month
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Grade
School Name
Please Select
Crofton ES
Crofton Meadows ES
Crofton Woods ES
Nantucket ES
Piney Orchard ES
Four Seasons ES
SOTI
Crofton Middle
Central Middle
AACPS ES Other
AACPS Middle Other
PGCPS ES Other
Private
Public Other
Other
What academic goals do you have for your child(ren)?
Subjects
Math
Reading
Both
Instruction Preference Type:
Online
In Person
Preferred Day:
Monday
Wednesday
Thursday
Preferred Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
20
40
Minutes
PM
AM/PM Option
Clear Fields
Back
Next
Payment Preference
How would you like to pay
Please Select
ACH
Credit Card (4% Processing Fee)
Check (Requires one month tuition Deposit)
Cash (Requires one month tuition Deposit)
We offer three payment options for tuition fees. Automatic withdrawal (ACH) from a checking account on the 25th of the month. Bring a voided check or bank document with routing and checking information. Cash or check requires one month's tuition as a deposit to start services. Credit card requires one month's tuition as a deposit plus a 4% processing fee. Based on your prorated day, the amount needed to start is provided below. The cost varies depending on your preferred payment method.
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