Kaplan Tutoring Services

STUDENT REGISTRATION FORM

Please print and fill out the form below and send it with payment to:

Kaplan Tutoring Services
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?__________________________