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New Student Registration

Student Information:

Student Name *

First

Last

Grade Level *

Student Phone (optional) *

Would you like to receive text reminders? *

Yes No

Student Email Address (if applicable) *

Area(s) you'd like to focus on in your sessions: *

Math Reading Writing Science Social Science Foreign Language Organization & Study Skills Homework Help Test Preparation Academic Enrichment App Development (Coding) Other

Favorite Subjects *

Least Favorite Subjects *

What grades did you earn in the last grading period? *

School Name: *

Birthday (Month/Day/Year) *

Choose One *

Male Female

Names & ages (or grades) of siblings *

Do you prefer a male or female tutor? *

About how often would you like to meet? *

One session per week Two sessions per week Three sessions per week Four or more sessions per week Other

Frequency of sessions can be changed at any time.

Desired Days/Times for Sessions *

Activities and interests outside of school *

Any upcoming test dates we should know about? *

What do you hope to earn in the next grading period? *

Parent Information:

Parent Name *

First

Last

Additional Parent Name (optional) *

First

Last

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Additional Phone Number *

Additional Email *

Referred by: *

Anything else we should know? *

Electronic Signature *

I have read and agree to the terms and conditions outlined in the Client Agreement.

Submit Registration

Our Clients
Our Services
Our Team
FAQ
Contact

New Student Registration

Student Information:

Parent Information:

SANTA MONICA * BRENTWOOD * PACIFIC PALISADES Copyright © 2017 ALDEN LEARNing. All Rights Reserved.

SANTA MONICA * BRENTWOOD * PACIFIC PALISADES
Copyright © 2017 ALDEN LEARNing. All Rights Reserved.