Thank you for your payment! Now, let’s get to work!

Student Name *

First Name

Last Name

Student Phone *

(###)

###

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Parent/Guardian 1 Name *

First Name

Last Name

Parent/Guardian 2 Name

First Name

Last Name

Permanent Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

By checking the boxes below: *

I agree to follow the tutoring and homework schedule

I agree to participate in the new EdTech platform for one year after launch.