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S.E.S. (No Child Left Behind) Pre Registration Form

Please fill out a FERPA Waiver, which will enable our company to exchange information with your child’s or children’s school. You may fax, mail or give the FERPA to their tutor.

DOB

Home Phone

Parents Phone

Present School

Grade

School Address

First Name

Subject 1 ( Need Help )

Subject 2 ( Need Help )

Subject 3 ( Need Help )

State

Zip

Home Phone

Cell Phone

Email Address

First Name

Last Name

Address

Parent Information

Student Information