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Student | Parent Contact information
Please provide the following preferred methods of communication you authorize for both you, the parent, and your child(ren) the student(s).
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* Indicates required question
Parent(s) Name
*
Your answer
Parent Email (Billing)
*
Your answer
Additional Parent Email
Your answer
Parent Phone number
*
Your answer
Additional Parent Phone number
Your answer
Mailing | Physical Address
*
Your answer
Grade(s)
*
Post-graduate
Undergraduate
Senior
Junior
Sophomore
Freshman
8
7
6
5
4
3
2
Other:
Required
Student (1) Name
*
Your answer
Student (1) Email
Your answer
Student (1) Phone number
Your answer
Student (2) Name
Your answer
Student (2) Email
Your answer
Student (2) Phone number
Your answer
How may I be of the most service to you and your children?
Your answer
Any special attention or behavior concerns, educational or special needs, or just something I should know to make this the most positive experience for all.
Your answer
How much does the student currently enjoy school?
*
Not at all
1
2
3
4
5
Very much
Are you considering Online or Live in-person Tutoring or Test Preparation Workshops?
*
Live in-home [$99/90min]
Live @ library [$65/60min]
Online
https://blakespace.thelessonspace.com/help/getting-started
[$25/30min]
Online other [$20/15min]
ACT | SAT | ACT+ six hour online success workshop: small-group study test techniques and jam sessions over three days [$149 each, $175 family]
None
Other:
Required
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