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Introduction
Programs
Learning Centers

ADMISSION

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Admission Form

Student's first name*

Student's last name*

Student's date of birth*

Month

Day

Year

Parent Full Name*

Parent's email*

Phone*

Address

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Program Interested*

AFTER SCHOOL PROGRAM

1-1 TUTORING

NY STATE TEST PREP. (Saturday: 9 am-12 pm)

SUMMER CAMP

WINTER RECESS

SPRING RECESS

Choose starting date*

Day Selection

Monday

Tuesday

Wednesday

Thursday

Friday

SCHOOL your child attends*

Branch*

Find the nearest learning center for your visit! Choose your preferred branch.

Does your child have any ALLERGIES or other medical/behavior information we should be aware of.*

Choose an option

Authorized Person for Pickup

Name

Relationship

Phone Number

Emergency Contact Detail *

Name*

Phone Number (Emergency Contact )*

Relationship*

Signature*

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Introduction
Programs
Learning Centers

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