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Plan Share- Secondary Student Registration
If you are sharing The Learning Pal services with another family, please use this form to register your student(s). Please note, your student will be added to the service plan selected by the family that completed the Primary Student Registration Form.
Customer/Parent Contact
Customer/Parent First Name
Email
Customer /Parent Last Name
Phone (xxx-xxx-xxxx)
Street Address
City
State
Zipcode
Please provide the name (first and last) of the parent/guardian with whom you are sharing this plan
Student #1
Student #1 (First Name)
Date of birth (xx/xx/xxxx)
Student #1 (Last Name)
Student #1 Gender
Female
Male
Non-binary
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Student #1 Grade
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
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Studet Extra-Curricular Interests
STEM
Arts & Crafts
Fitness/Sports
Music
Nature/Gardening
Cooking
Learning Abilities
ESOL/ELL
IEP
Dyslexia
Learnng Styles
Visual
Auditory
Kinesthetic
Verbal
Logical/Mathematical
Social
Solitary
Combination
Student #1 -Allergies/Health Concerns
Student #1-School Attending
(Student #1) Please provide any additional details that would assist the Learning Pal in supporting your student.
Student #2
Student #2 (First Name)
Date of birth (xx/xx/xxxx)
Student #2 (Last Name)
Student #2 Gender
Female
Male
Non-binary
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Student #2 Grade
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
arrow&v
Studet Extra-Curricular Interests
STEM
Arts & Crafts
Fitness/Sports
Music
Nature/Gardening
Cooking
Learning Abilities
ESOL/ELL
IEP
Dyslexia
Learnng Styles
Visual
Auditory
Kinesthetic
Verbal
Logical/Mathematical
Social
Solitary
Combination
Student #2 -Allergies/Health Concerns
Student #2-School Attending
(Student #2) Please provide any additional details that would assist the Learning Pal in supporting your student.
Student #3
Student #3 (First Name)
Date of birth (xx/xx/xxxx)
Student #3 (Last Name)
Student #3 Gender
Female
Male
Non-binary
arrow&v
Student #3 Grade
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
arrow&v
Studet Extra-Curricular Interests
STEM
Arts & Crafts
Fitness/Sports
Music
Nature/Gardening
Cooking
Learning Abilities
ESOL/ELL
IEP
Dyslexia
Learnng Styles
Visual
Auditory
Kinesthetic
Verbal
Logical/Mathematical
Social
Solitary
Combination
Student #3 -Allergies/Health Concerns
Student #3-School Attending
(Student #3) Please provide any additional details that would assist the Learning Pal in supporting your student.
I have read and agree to The Learning Pal Terms & Conditions. By clicking accept, I am signing this Contract on my own free will and agree to be obligated under its terms. View
Terms & Conditions
I certify that the information I have provided herein is true and accurate and that I am the parent or legal guardian authorized to sign this form, releases and waivers.
I do hereby give permission to The Learning Pal LLC to use my child’s image/likeness on video or a photographic picture of my child on the website (www.thelearningpal.com), newspapers, magazines, television or other mediums used to promote The Learning Pal services, activities and/or for marketing purposes. Usage of this picture may include the use of my child’s first name along with an article or other content about The Learning Pal. I understand that there will be no remuneration for the use of any likeness of my child used for the purposes stated above. At my request, The Learning Pal will provide me with copies of any articles, brochures or mediums (if available) in which my child’s picture or likeness has been used.
I agree to The Learning Pal Cancellation and Refund Policy. View
Policy
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