Math Academy Student Registration Form
Kindly fill up the form below to register for a slot at Math Academy.
Reservation of slot is only confirmed once the deposit of $100 has been made.
Bank transfer/cash/cheque are welcomed.
Student's Name: *
Your answer
School *
Your answer
Level *
Required
Date of birth *
MM
/
DD
/
YYYY
Parents' Mobile Number (Indicate Mom or Dad or both)
Your answer
Student's Mobile Number *
Your answer
Parent's Email Address (Payment invoices will be sent to this email address): *
Your answer
Home Address: *
Your answer
Recent Marks (CA / SA):
Your answer
How did you get to know about us? (You may select more than one answer)
We offer a $50 referral fee for each student referred to us. If you were referred by an existing student, please indicate his/her name below:
Your answer
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