STUDENT REGISTRATION FORM

STUDENT REGISTRATION FORM

If you prefer to fill this form out and submit it online, please click here.

Otherwise, please print and fill out the form below and send it with payment to:

Kaplan Tutoring Services Inc.
5 Karen Drive
Barrington, RI 02806

Name of Participant_________________________________________________________

Street Address______________________________________________________________

City_____________________________________State_______Zip Code_______________

Home Phone__________________________Email___________________________________

School__________________________________________________________Grade_______

Name of Parent/Guardian___________________Cell/Emergency Phone______________

Course Title_____________________________________Total Enclosed_____________

Date/Time/Place (if applicable)_____________________________________________

Where did you hear about Kaplan Tutoring Services?__________________________