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* Indicates required question
Parent Name (First and Last)
*
Your answer
Student Name (First and Last)
*
Your answer
Student Grade Level (2022-2023 School Year)
*
Your answer
Email
*
Your answer
Phone Number
*
Your answer
What school do you attend?
*
Your answer
Subjects interested in:
*
Math
Physics
Computer Science
Chemistry
Chinese
English
Other:
Required
Desired class frequency?
*
Once per week
Once every two weeks
Other:
Any additional information we need to know?
Your answer
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