< Return to Home Page
Waiting List Registration
Course Selected
Rate
Please complete the WAITING LIST registration form below
Student's First Name (Required)
* - First name required
Student's Last Name (Required)
* - Last name required
Student's Nickname
Student's Cellphone Number (Required)
* - Student's cellphone number required
Street Address
City
State
ZIP
Student's E-Mail (Required)
* - Student E-Mail Required
Student's School
8
9
10
11
12
Student's Grade (Required)
* - Student's Grade required
2024
2025
2026
2027
2028
2029
Graduation Year (Required)
* - Graduation year required
Parent E-Mail (Required)
* - PARENT e-mail address required
Dr.
Miss
Mr.
Mrs.
Ms.
Parent Title
Parent Full Name
Parent Cellphone (Required)
Phone number must include area code.
* - Parent cellphone required
Which day(s) and time(s) of the week do you prefer for tutoring?
Note: tutoring is not available prior to 3:00pm from Sunday to Friday, and is only available in the AM on Saturdays.
Additional Comments
Cancellation Agreement:
A scheduled appointment must be cancelled with at least 24 hours notice. Failure to cancel with proper notice will result in a charge of $90.
I understand and agree to the Cancellation Agreement.
You must accept the CANCELLATION AGREEMENT
Submit
Cancel