Enrollment Form Notify Dragonfly Education Enrollment FormClient Information:DateParent/Guardian 1:Parent/Guardian 2:First NameLast NameEmail 1Phone/MobileAddress InformationAddress Line 1Address Line 2CityStateZip CodeTutoring takes place at this address?- Select -YesNoFirst NameLast NameEmail 2Phone/MobileAddressAddress Line 1Address Line 2CityStateZip CodeTutoring takes place at this address?- Select -YesNoStudent 1:Student NameSchoolAgeGradeArea of TutoringPhone/MobileEmailBirthdayTeacher(s)CommentsAvailable days to be tutored:SundayThursdayMonday FridayTuesdaySaturdayWednesdayStudent 2:Student NameSchoolAgeGradeArea of TutoringPhone/MobileEmailBirthdayTeacher(s)CommentsAvailable days to be tutored:SundayThursdayMonday FridayTuesdaySaturdayWednesdayTutoring Package -Sessions/WeekHours/SessionBlock of HoursRate/HourMaterials FeeRegistration FeeSub TotalTotal InvestmentPayment Method:- Select -American ExpressDiscoverMastercardVisaCheckCashPayment Plan: Paid In Full InstallmentsPayment Plan Installments:Payment Rate:Note: Monthly payment plans are equal installment plans and do not reflect the hours used. Registration and material fees will be added to the first payment. Materials and registration fees are non-refundable.Name of Card HolderCard NumberExpirationCSV/CVVNote: To cover the cost of credit card acceptance, we pass on a 3% credit card fee. This fee is not more than the cost of accepting these cards. There is no fee for debit cards.Submit Form