BLE Academy Tutoring Registration

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This form must be completed for each new student. After school programs and tutoring is available on a month to month basis. This means that you are not required to take the class/course for an entire school year. Please put N/A in any section that does not apply.

电子邮件地址 *

Child's Legal Name *

Child's Email Address *

CITY and STATE *

Child's Gender *

Female

Male

Parent/Guardian #1 Name *

Parent/Guardian #1 Email Address *

Parent/Guardian #1 Address (include city and state) *

Parent/Guardian #1 Phone Number *

Parent/Guardian #2 Name *

Parent/Guardian #2 Address (include city and state) *

Parent/Guardian #2 Phone Number *

Parent/Guardian #2 Email Address *

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