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Student First name
*
Student Last name
*
Student's Date of Birth
*
Month
Month
Day
Year
Parent's Full Name
*
Parent's email
*
Phone
*
Multi-line address
Country/Region
*
Address
*
City
*
Zip / Postal code
*
Select the Program you're registering for
*
AFTER SCHOOL
PRIVATE TUTORING
NY STATE TEST PREP (January 10th - May 2nd)
SUMMER CAMP
Choose Starting Date
*
SCHOOL your child attends
*
GRADE LEVEL IN SEPTEMBER 2025
*
FOR all students, Let us know about updated ALLERGY list/ or other medical/behavior information IKLASS should be aware of about your child. IF NONE/ PUT "NONE"
*
Emergency Contact Person FULL NAME
*
Relationship to the child
*
Phone Number (Emergency Contact )
Authorized Person for Pickup FULL NAME
Relationship to the child
Enter Authorized Persons Phone Number
Signature
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