PROGRAM reGISTRATION

tutoring-baltimore

Registration Form

Complete/Submit Registration Form

Student Name *
Student Name
Birthday *
Birthday
We only accept students entering grades 1 thru 9 next school year.
Parent Name *
Parent Name
Parent Mobile Phone Number
Parent Mobile Phone Number
Parent Work Phone Number
Parent Work Phone Number
Address *
Address
Program Weeks *
Select the weeks your child will attend the program. Weeks 1, 2 & 4 ARE SOLD OUT !
Field Trips *
Select the field trips your child will attend.
Allergies, Asthma, ADHD, Behavior Issues, Anxieties...
Emergency Contact *
Emergency Contact
The emergency contact must be a different person with a different contact number than the registering parent.
Emergency Contact Mobile Phone Number
Emergency Contact Mobile Phone Number
Student T-Shirt Size *
Students who register after June 2, 2018 will not receive a STEM T-Shirt. They will receive a solid color T-shirt w/o a STEM logo.
Payment Type: Program Fee *