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Kumon Silver Spring - Registration Form
This form is for both new and transfer students. Each student is required to submit seperate form. Please submit the form before your scheduled visit.
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* Indicates required question
Student Last Name
*
Your answer
M.I
Your answer
Student First Name
*
Your answer
Birth Month
*
Choose
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Day
*
Your answer
Year
*
Your answer
Gender
*
Choose
Female
Male
School Year, e.g. 2018-2019
*
Your answer
Grade
*
Choose
PK-3
PK-2
PK-1
K
1
2
3
4
5
6
7
8
9
10
11
12
other
Home address: street & number
*
Your answer
Apt. or Suite No.
Your answer
City
*
Your answer
State/Province
*
Your answer
Zip/Postal Code
*
Your answer
Email
Please provide an email address for the student, if any.
Your answer
Area Code - Home Telephone
*
Your answer
Name of School
*
Your answer
Do you plan to enroll the child into Math or Reading or both? A free placement test will be conducted so that they start at proper level. We strongly recommend that the student enrolls into both for a balanced learning all along.
*
Math
Reading
Required
Preferred Attendance Day & Time
*
e.g: Wed 5:00PM & Sat 11:00. Please see center class hours for reference. 30 min for each signed up subject, twice a week.
Your answer
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