Inside Acceleration
Tutoring Center
Student Registration
Inside Acceleration Tutoring Center
Additional documents for registration
• Parent/Guardian identification card
Student Information
Name
*
First Name
Last Name
Birth Date
*
-
Month
-
Day
Year
Date Picker Icon
Gender
*
Please Select
Male
Female
Email Address
*
Phone Number
*
Please enter a valid phone number.
Grade
*
Current school name
*
Tutoring subject(s):
*
Math
Reading
Writing
Please list (if any) learning disabilities or N/A
Tutoring plan (only choose 1)
*
6 months - 1 subject $150
6 months - 2 subjects $250
6 months - 3 subjects $350
12 months - 1 subject $145
12 months - 2 subjects $245
12 months - 3 subjects $300
Discount you qualify for (if any) - proof is required.
10% off sibling
5% off annual prepaid plan
10% off military
Session preference
*
In-Person
Online Only
Both
I understand if "online only" sessions were chosen, that does not change the price, terms, conditions, or expectations for my family. I am aware that all payments, forms and documentation will be completely virtually if I chose "online only" as my session preference.
*
I understand
Does not apply
I will remember to schedule my scholar(s) a free assessment Link to schedule: https://calendar.app.google/jUPu8cegtevds2Se9
*
I Agree
Current Residence Information
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone Number
*
-
Area Code
Phone Number
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Emergency Contact 1
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Emergency Contact 2
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Physician and Medical Information
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Preferred Hospital
*
Insurance/Health Coverage (Company)
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.
*
Please inform the office of any other vital information you think they may need to know in the event of an emergency. Thank you.
*
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Did a current student/family refer you?
Submit
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