Student REgistration

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Student REgistration

Student Name

First Name

Last Name

Student Email

Student Phone

(###)

###

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Subject(s) to be Tutored

Grade Level

School

Payer

Person responsible for payment.

Pricing

Please select the pricing option for your student:

$65/hr - Grades K-5

$85/hr - Grades 7-12

$105/hr - College Level

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

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Digital Signature

First Name

Last Name

Date

MM

DD

YYYY