For Middle & High Schooler
Time: 11:00 AM - 1:00 PM
Signing up for tutoring session in: (check all that applies)
*
Math
English
Date of Community Tutoring:
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Location
6300 Independence Pkwy, Ste A, Plano, TX 75023
I am a (select what best applies to you)
*
Parent
Student
Student's Full Name
*
First Name
Last Name
Grade
*
Please Select
Middle Schooler
HIgh Schooler
Date of Birth
*
-
Month
-
Day
Year
Student's Email
*
Student's Phone Number
*
Please enter a valid phone number.
Mother Full Name
*
First Name
Last Name
Mother Email
*
example@example.com
Mother Phone Number
*
Please enter a valid phone number.
Father Full Name
*
First Name
Last Name
Father Email
*
example@example.com
Father Phone Number
*
Please enter a valid phone number.
How many kid(s) will be attending story time?
*
Please Select
1
2
3
4
1. Child's Age
*
Numbers Only
2. Child's Age
*
Numbers Only
3. Child's Age
*
Numbers Only
4. Child's Age
*
Numbers Only
Select all that applies
*
Parent of a Toddler
Parent of Elementary
Parent of Middle School
Parent of High School
Parent of a College Student
Other
How many people will be attending this event including you? (Number of Family members only)
*
Numbers Only
How did you hear about this program?
*
Whatsapp
GEM Newsletter
Facebook
Friend
Word of Mouth
Instagram
Other
*
Submit
Should be Empty: