Home
About Us
Our Team
Summer Classes
Summer Schedule
Fall Classes
Tutoring Services
For Parents
Contact Us

Please complete the following Registration Form. Your class selection and payment will be processed on the next page.

Parent First Name: *
Parent Last Name: *
Email: *
Telephone: *
Cell Phone:
Mailing Address: *
City, State, Zip Code: *
# of Registrations: *
Child's First Name: *
Child's Last Name: *
Child's Age: *
Grade Level for 2010-2011: *
School Attending: *
Any Known Learning Disabilities:
List 3 Strengths & 3 Weaknesses
of the Learner: *
2nd Child's First Name:
2nd Child's Last Name:
2nd Child's Age:
Grade Level:
School Attending:
Any Known Learning Disabilities:
List 3 Strengths & 3 Weaknesses
of the Learner:
How did you hear about us?: *
If you answered "other" above, please specify:
Message:

Cancellation Policy:

A full refund will be given to cancellations made prior to the first day of class. In the event you need to cancel, please email us at info@raisingthebarcc.com or call us at 832-661-5407.