Learning Strategies Session Registration (new clients)

Learning Strategies Session Registration (New Clients)

The red asterisk notes a required field. If you have any questions, please email or call us.

* Indicates required field

Student Name *

First

Last

School *

Grade Level *

Student Email *

Student Phone *

Parent/Guardian 1 Name (primary contact/responsible for payment) *

First

Last

Parent/Guardian 1 Email *

Parent/Guardian 1 Phone *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Guardian 2 *

First

Last

Parent/Guardian 2 Email *

Parent/Guardian 2 Phone *

Additional Info (special needs/requests, medications, learning challenges, relevant medical diagnoses, etc.): *

Referred by *

Agreement to terms *

I understand that there is no refund if I cancel for any reason less than one week in advance of the session. If I register less than one week in advance, then there is no refund if I cancel for any reason. I understand that email addresses listed on this sign-up form may receive occasional emails from MindGarden, but email addresses will not be shared with anyone else. You can unsubscribe from our list at any time.

After clicking the "REGISTER NOW" button below, you will be re-directed to the credit card authorization page to complete the registration process. We will contact you about confirming your registration. If you are not contacted within 48 hours of submitting this form, please contact us to verify that we received your registration.

All information submitted on this form is confidential and will not be shared with any other parties.

MindGarden Tutoring

Learning Strategies Session Registration (New Clients)