Wordpress Tutorial Student Registration Form

Tutorial Student Registration Form

Please complete the form below. Our coordinators will contact you within 24 hours to confirm your schedule.
Basic Information
Student Full Name

First NameLast Name
Parent's Name

First NameLast Name
School Information

School Name

County

CityState / Province

Postal / Zip CodeCountry
Year Level
Foundations (K–3)
Discovery (Grades 4–8)
College Prep (Grades 9–12)
Select Attendance Days for Foundations (K–3) Students
Select Attendance Days for Discovery (Grades 4–8) Students
Select Attendance Days for College Prep (Grades 9–12) Students
Monday Time
Tuesday Time
Wednesday Time
Thursday Time
Friday Time
Saturday Time
Sunday Time
Total Number Of Sessions In a Month (Foundations)
Total Number Of Sessions In a Month (Discovery G4-8)
Total Number Of Sessions In a Month (College Prep)
Total Monthly Tutorial Fee (Foundations)
$15 per hour rate
Total Monthly Tutorial Fee (Discovery G4-8)
$17 per hour rate
Total Monthly Tutorial Fee (College Prep)
$20 per hour rate
Final Total Monthly Tutorial Fee
Parent Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent E-mail
example@example.com
Student Mobile Number (Requires Parent Approval)
Please enter a valid phone number.Format: (000) 000-0000.
Suggestions / Comments

Tutorial Service Payment

USD for each month

Tutorial Student Registration Form