Student Registration Form

Student Registration Form

Please ensure you fill out the form in its entirety.
Student Name

First NameLast Name
Birth Date

MonthDayYear
Gender
Student Expected Grade Level for Fall 2021
Parent/Guardian Name

First NameLast Name
Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Email

Confirmation Email
Phone Number

Area CodePhone Number
Class Sessions

Sessions run from July 5, 2021 through July 29, 2021.
Class Sessions
Please note that your child can only be enrolled in one session. Select all sections that work with your schedule and we will notify you the session in which your child is enrolled.
Does your child have access to an electronic device and internet connection? At this time, all students must have access to an electronic device capable of video calling on platforms such as Zoom as well as internet connection.
I allow tutors and teachers affiliated with YLI to instruct my child academically twice a week for the month of July 2021. All contact between the tutor and my child will take place in class, or through contact with the parent/guardian.
If you have any specific areas in which you know your child needs assistance in, list them below. Additionally, please note any information about your child that is pertinent to their learning experience.
Should be Empty:

Class Sessions