2024 Tutoring Workshops Registration

Parent's Name*

First NameLast Name
Student's Name*

First NameLast Name
Parent's Email*
example@example.com
Parent's Phone Number*
Please enter a valid phone number.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What school does your student attend?*
Student's Grade*
PARENT Primary Language
STUDENT Primary Language
Please choose which sessions you are committed to attending.*

Tuesday, October 22nd - 4-6:30PMWednesday, October 23rd - 4-6:30PMThursday, October 24th - 4-6:30PMAll of the above
Please choose which sessions you are committed to attending.*

Tuesday, November 12th - 4-6:30PMWednesday, November 13th - 4-6:30PMThursday, November 14th - 4-6:30PMAll of the above

Tell us about your student. Why are you signing them up for tutoring? What areas are they needing help in?*
Please list any allergies or food preferences:
Do you give us permission to take photos of your student for the sake of our website and social media?*
Would you like your email to be added to our monthly newsletter?*
Is there anything else we need to know about your student for this program?
I, the parent/guardian of the student listed above, attest that the information listed above is accurate. I understand my responsibility in this program is to have my student arrive on time, prepared, to each tutoring session. *

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Questions? Contact us at bridge.leadership2k@gmail.com
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Welcome to BLA's Tutoring Program for 2024!