MathAltitude, LLC  *  35 Harvard St. Suite 211, Worcester, MA 01609  *  (860) 37-LEARN (375-3276)

Copyright 2011 - 2017

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(860)-37-LEARN (375-3276)

Enrollment is open for 2017-2018 School Year

Small classes are filling fast. Register now to reserve your seat

You can submit your secure on-line registration electronically by clicking “Submit Application” button below

or

you can print filled form by clicking “Print” button and mail or deliver it to us in person.

Please note that we will never share, sell or distribute in any other way your personal information.

I have read, understood and agree to follow MathAltitude Policies

I

Note: New students will be placed into our program based on the results of the evaluation test

(enter your initials)

authorize,

do not authorize MathAltitude to use still photos or video of my child for

publicity purposes.

Select Class 1

Student Information

First Name

M.I.

Last Name

Gender

DOB

School Attending

Grade in Sept. 2017

Parent’s Information

Home Address

City

Home Phone

ZIP

Parent 1 Name

Occupation

Cell/Work Phone

Contact E-mail

Parent 2 Name

Occupation

Cell/Work Phone

Contact E-mail

Medical Insurance Information

How did you find out about MathAltitude?

Subscriber’s Name

Insurance

Subscriber Number

Group Number

Are there any medical conditions we should know about?


From a friend

Magazine/newspaper

Internet

Other

Refered by

Select Payment Plan

Please register my child for:    

Summer Program 2017    

2017-2018 School Year    

Private Tutoring    

Class 2