2024 Spring Student Class Registration

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Please fill out the form to the best of your knowledge. We will contact you upon receipt to confirm and to clarify if needed.

Email *

Today's Date *

YYYY

Student First Name *

Student Middle Name

Student Last Name *

Student Grade: *

What grade is your student in for the 2022-2023 Academic Year?

Student School District: *

Which school district will your student attend in the 2022-2023 Academic Year?

If you selected "Other," please let us know what School District your student goes to:

Student School: *

Which school will your student attend in the 2022-2023 Academic Year?

Is your Student First-Time Enrolling or Returning? *

First-time enrollment has a one-time mandatory new student enrollment fee of $30

First-Time Enrolling

Returning Student

Gender: *

Male

Female

Prefer not to say

Parent First Name: *

Include the name of the parent who is the preferred point of contact regarding this student.

Parent Last Name: *

Include the name of the parent who is the preferred point of contact regarding this student.

Parent Preferred Title: *

Mr.

Ms.

Mrs.

Dr.

Other:

Main Contact Email Address: *

Please use the email you would like us to use for communications. If you would like to add a second email, please fill out below.

Secondary Contact Email Address:

If you would like to add a second email address to be included in communications, please do so here.

Preferred Primary Phone Number: *

Please include your preferred phone number for communication regarding this student.

Alternate Phone Number:

If you would like to include an alternate phone number, please do so here

Emergency Contact Name: *

Please include your Emergency Contact's First and Last name.

Emergency Contact Phone Number: *

Home Address: *

What is your class format preference? We are planning for a hybrid format, however that is subject to change at any time based on CDC/federal/state/local rules. *

In-person ONLY

In-person Preferred

Online ONLY

Referred by?

If you were referred to Summit by someone who was previously a student here, please include the student's full name here. Referrers will receive a $20 credit towards their next tutoring if the referred student stays with STC for at least one session.

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