Student Enrollment Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for your interest in Double A + Tutorials for your math tutorial needs. By filling this the form out you are now eligible for a 5% Discount for your first 4-Week Cycle of sessions. Please note that by filling out this form, you are not obligated to finish the enrollment process or attend any sessions. This form is for informational purposes to ensure we meet all of your requirements.

What is the Student's Name? *

How did you hear about us? *

Referral

Website

Social Media

Post Card Advertisement

Magazine Advertisement

Sanitizing wipe Advertisement

What Grade is the student in? *

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

8th Grade

9th Grade

10th Grade

11th Grade

12th Grade

College

Other:

What Math Subject is the student currently taking? *

Lower Grade Level Math

Pre-Algebra

Algebra I

Geometry

Algebra II

Pre-Calculus

Calculus (AB or BC)

SAT, ACT, and other Testing Mathematics

College Level Math

Other:

Required

What school does the student attend? *

What is the parent/guardian's name? (if Applicable)

Not Applicable

Other:

Clear selection

What plan are you interested in? *

Once a Week: This plan includes ONE SCHEDULED 90-minute session for each week during the 4-week cycle for a total of 4 sessions to use during that 4-week cycle. This day is the same day and time for each cycle unless otherwise discussed.

Twice a Week: This plan includes TWO SCHEDULED 90-minute sessions for each week during the 4-week cycle for a total of 8 sessions to use during that 4-week cycle. These days are the same days and times for each cycle unless otherwise discussed.

Three Times a Week: This plan includes THREE SCHEDULED 90-minute sessions for each week during the 4-week cycle for a total of 12 sessions to use during that cycle. These days are the same days and times for each cycle unless otherwise discussed.

Walk In: This is ONE 90-minute session that is not a part of the 4-Week plan cycle and is on an as needed basis.

Unsure or would like the diagnostic test to help determine the number of days a week the student comes.

What day of the week and time of day are you interested in?

4:30 p.m. to 6:00 p.m. (Mon-Thurs ONLY)

5:00 p.m. to 6:30 p.m. (Mon-Thurs ONLY)

5:30 p.m. to 7:00 p.m. (Mon-Thurs ONLY)

6:00 p.m. to 7:30 p.m. (Mon-Thurs ONLY)

6:30 p.m. to 8:00 p.m. (Mon-Thurs ONLY)

7:00 p.m. to 8:30 p.m. (Mon-Thurs ONLY)

9:00 a.m. to 10:30 a.m. (Sat ONLY)

9:30 am to 11:00 a.m. (Sat ONLY)

10:00 a.m. to 11:30 a.m. (Sat ONLY)

10:30 a.m. to 12:00 p.m. (Sat ONLY)

11:00 a.m. to 12:30 p.m. (Sat ONLY)

11:30 a.m. to 1:00 p.m. (Sat ONLY)

UNSURE

Monday

Tuesday

Wednesday

Thursday

Saturday

UNSURE

4:30 p.m. to 6:00 p.m. (Mon-Thurs ONLY)

5:00 p.m. to 6:30 p.m. (Mon-Thurs ONLY)

5:30 p.m. to 7:00 p.m. (Mon-Thurs ONLY)

6:00 p.m. to 7:30 p.m. (Mon-Thurs ONLY)

6:30 p.m. to 8:00 p.m. (Mon-Thurs ONLY)

7:00 p.m. to 8:30 p.m. (Mon-Thurs ONLY)

9:00 a.m. to 10:30 a.m. (Sat ONLY)

9:30 am to 11:00 a.m. (Sat ONLY)

10:00 a.m. to 11:30 a.m. (Sat ONLY)

10:30 a.m. to 12:00 p.m. (Sat ONLY)

11:00 a.m. to 12:30 p.m. (Sat ONLY)

11:30 a.m. to 1:00 p.m. (Sat ONLY)

UNSURE

Monday

Tuesday

Wednesday

Thursday

Saturday

UNSURE

Clear selection

What is a good contact number for the parent/guardian? *

What is a good contact email for the parent/guardian? *

What is your preferred method of contact so we can contact you with any questions regarding this form? *

Call

Text

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms