Tutorial Registration Form

Tutorial Registration Form

Fill out the form carefully for registration
Student Name

First NameMiddle NameLast Name
Student Birth Date

MonthDayYear
Student Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail
example@example.com
Mobile Number
Current Grade of Student
Parent Email
example@example.com
Parent Mobile Number
Parent Work Number
Important Information (Please include any IEP's, 504 Plans, allergies, special accommodations) Also include any information that you feel will be necessary for your Childs success while being a student at WizeHouse Academy.
Additional Comments. Login Numbers to Various Platforms. Test Dates
File Upload (Necessary documents applicable: report cards, progress reports, IEP's, 504 Plans, Psychology or Speech reports, etc)

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