Two Teachers Tutoring ACT Boot Camp Registration

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This form is to register for our ACT Boot Camp at COOSA PINES FEDERAL CREDIT UNION Childersburg branch. The session will be held on Saturday, July 11 from 9:00 a.m. to 12:30 p.m. CST.

Your $120 payment is due at check in. Please arrive 15 minutes early to sign in and make your payment.You may also pre-pay with Venmo @Chamiller.

Thank you for registering and we look forward to working with you!

Email *

Student Last Name *

Student Preferred First Name *

Grade Level *

Freshman

Sophomore

Junior

Senior

What school do you attend? *

BB Comer High School

Chelsea High School

Childersburg High School

Coosa Valley Academy

Fayetteville High School

Pell City High School

Sylacauga High School

Winterboro High School

Other:

When are you taking the ACT? *

July 18, 2020

Other:

Have you taken the ACT previously? *

Yes

List your most recent ACT English score: *

List your most recent ACT math score: *

List your most recent ACT reading score: *

List your most recent ACT science score: *

List your most recent ACT composite score: *

List any health conditions that we need to know about. *

Please provide emergency contact and phone number. *

How did you hear about us? If someone referred you, please list his or her name. *

You will receive a confirmation email shortly. We will send a reminder email with additional details a few days before the event.

A copy of your responses will be emailed to the address you provided.

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