Registration for Summer Tutoring
Parent/Guardian Full Name
*
First Name
Last Name
Mobile Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
Name of Child
*
First Name
Last Name
What is your child's birthday?
-
Month
-
Day
Year
Date
What grade is your child currently in?
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
Any curriculum areas or skills that you'd like me to focus on? (Be specific if you wish)
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