SHSAT Test Prep Classes SUMMER 2018 Registration Form

Student Information

Student Name
Birth Date
Home Address
Home Phone
Email Address
Parent 1 / Guardian
Work Phone
Cell Phone
Parent 2 / Guardian
Work Phone
Cell Phone
Emergency contact: (Name)

Credit Card Information

Credit Card
Expiration Date
Postal Code

SHSAT – Summer Program
July 10 – August 16, 2018 – Tuesday  & Thursday • 5pm-8pm
90 Minutes ELA + 90 Minutes MATH
36 Hours of Instruction – 12 meeting times

By Clicking the Register Button Below Your Method of Payment Will Be Charged $1,440.00

Please read the terms below.


  • I hereby enroll the child named above and agree to ALL terms and conditions outlining the requirements of the SHSAT Program. Enrollment is for the time specified.
  • Leap Tutoring Academy reserves the right to dismiss any student whose behavior is disruptive to the program. In such cases, there will be no refund.
  • I grant to Leap Tutoring Academy and to its employees the right to photograph my child and to use these photographs or video recordings for print or electronic publishing.
  • No refunds for the program will be granted for classes missed, all classwork will be made available for classes missed.

I have read the above statement, and the terms and conditions listed, and agree to all terms indicated.

By typing my name I agree to the above with my digital signature.