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Registration Form
Registration and Payment Options.
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* Indicates required question
Email
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Your email
Student Name
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Your answer
Student Grade
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Choose
K
1st
2nd
3rd
4th
5th
6th
Student Birthdate
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MM
/
DD
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YYYY
Address
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Your answer
Caregiver's name
*
Your answer
Caregiver's phone
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Your answer
Day(s) that work for tutoring
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Monday
Tuesday
Wednesday
Thursday
Friday
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What time of day works best for tutoring? (Please note times are for CENTRAL time zone)
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Your answer
What tutoring package would you like?
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Choose
Tier II Gold Package (1 weekday @ 60 minutes) - $240 / month
Tier II Silver Package (1 weekday @ 30 minutes) - $140 / month
Tier III Gold Package (2 weekdays @ 60 minutes) - $480 / month
Tier III Silver Package (2 weekdays @ 30 minutes) - $280 / month
Will e-mail tutor to construct a special package
Thank you so much for your continued interest in the service. I look forward to reviewing the information.
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I understand that before booking a private 1:1 session an initial consultation and diagnostic assessment must be completed.
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