Dragonfly Education Enrollment FormFirst NameLast NameEmail 1Phone/MobileAddress InformationAddress Line 1Address Line 2CityStateZip Code Tutoring takes place at this address. Add additional client?First NameLast NamePhone/MobileAddressAddress Line 1Address Line 2CityStateZip CodeEmail 2 Tutoring takes place at this addressStudent NameSchoolAgeGradeArea of TutoringPhone/MobileEmailBirthdayTeacher(s)CommentsAvailable days to be tutored:Sun/SatMonTuesWedThursFri Add another student?Student NameSchoolAgeGradeArea of TutoringPhone/MobileEmailBirthdayTeacher(s)CommentsAvailable days to be tutored:Sun/SatMonTuesWedThursFri Add another student?Student NameSchoolAgeGradeArea of TutoringPhone/MobileEmailBirthdayTeacher(s)CommentsSun/SatMonTuesWedThursFriSessions/WeekSession LengthBlock of HoursRate/HourMaterials FeeRegistration FeeNumeric FieldTotal InvestmentPayment Method:- Select -American ExpressDiscoverMastercardVisaCheckCashPayment Plan: Paid In Full InstallmentsNumber of Payments:Payment Rate:NOTE: Monthly payments do not reflect hours used. Registration and material fees will be added to the first payment. Materials and registration fees are non-refundable.I have read and agree to the Terms and Conditions and Services Privacy PolicySubmit Form
