Brainbowz Online Tutoring
Student Registration Form
Name
First Name
Last Name
Age
* For students signing up for group lessons *
Street Address Line 2
City
State / Province
Postal / Zip Code
Student E-mail
Phone Number
-
Area Code
Phone Number
Tutoring Subject
Please Select
English
E/S/L
Spanish
Homework Assistance
Life Skills
SAT Prep
Tutoring ES/MS
Tutoring 9-12
Would you prefer One-on-One or Group Lessons?
*There are up to 6 students in a group lesson*
Tutoring Days - We are open every day from 9 am - 9pm EST.
Tutoring Time
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Hour
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10
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30
40
50
Minutes
AM
PM
AM/PM Option
Until
until
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8
9
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12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Number of Lessons Per Week
Please Select
1
2
3
4
5
6
7 +
Interests and Hobbies :
We incorporate your interests into your curriculum!
Questions or Comments :
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