Registration Form
Please fill out the form below and one of our representatives will contact you.
Student Full Name
*
Student Grade Level
*
Subjects
*
Bergen County Academies Test Prep
SAT Prep
PSAT Prep
ACT Prep
SSAT Prep
ISEE Prep
SHSAT Prep
MATH
ENGLISH
CHEMISTRY
BIOLOGY
PHYSICS
LITERATURE
Other
Parent E-mail
*
Parent Phone Number
*
Zip Code
Student Phone Number
*
How Did You Find Us?
Google
Facebook
Referral
Yelp
Direct Website
Physical Flyer
Other
Student Phone Number
-
Area Code
Phone Number
Monthly 1 on 1 Tutoring Plan Subscriptions
prev
next
( X )
Bronze
(
$
390.00
for each
month
)
Monthly 4 hours tutoring plan
Silver
(
$
720.00
for each
month
)
Monthly 8 hours tutoring plan
Gold
(
$
995.00
for each
month
)
Monthly 12 hours tutoring plan
Platinum
(
$
1,280.00
for each
month
)
Monthly 16 hours tutoring plan
Email
Payment Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
SUBMIT
Should be Empty: