Online Registration
A $25 non-refundable Registration Fee must be submitted with the online registration form.

Disclaimer: The registration form is not a contract for services. The registration form adds your student to our waitlist. The amount of time on the waitlist is dependent upon tutor availability and your scheduling preferences.
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Parent/Guardian 1 (Last Name, First Name) *
Parent/Guardian 2 (Last Name, First Name)
Email address (Primary Parent/Guardian) *
Address *
City *
State *
ZIP Code *
Primary phone number *
Primary Phone Number is For: *
Secondary phone number
Secondary Phone Number is For:
Parent/Guardian 1 Employer *
Parent/Guardian 2 Employer
Emergency contact name *
Emergency contact phone number *
Relationship of emergency contact to student *
Would you like to receive your billing statements by email? *
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