testpage Student's First Name (required) Student's Last Name (required) School Name (required) Grade (required) Parent's First Name (required) Parent's Last Name (required) Parent’s Email (required) Phone (required) Address (required) City (required) State (required) Zip Code (required) Math and Coding Course Options Math $149 per month for the first studentMath $129 per month for the second student/Second subject with family plan discountMath $109 per month for the third student with family plan discountCoding $149 per monthComputer Basic Skill for Adults $149 per MonthEnglish as Second Languages for Adults $149 per MonthPrivate One-to-one Tutoring any subject $45 per hourELA Reading Writing $149 Per monthELA Reading Writing $129 per month for the second student/Second subject with family plan discount Special Needs Does your child have any learning differences? [radio* special_needs "Yes" "No"] If you chose 'Yes', please elaborate: Would you like your child to focus on specific areas in learning? [radio* focusarea "Yes" "No"] If you chose 'Yes', please elaborate below: Is there anything else you would like us to know about your child? Signature I have read and understand the UTOPIA MATH Academy enrollment packages, and I will support and maintain a learning environment that is safe and fun for all studentsI understand the Utopia Math Academy expectations and consequencesI understand that I can request to cancel enrollment at any time, parents and/or Adult Students must submit a cancellation request in writing, either by text or email, at least 30 days before the last desired date of attendanceRegistration and processing fees of $59 per student. The monthly tuition is due in advance, on the 1st day of the month. Registration fee and monthly tuition are non-refundable Parent Signature - Place your signature in the box below (use the clear button to clear it) Date I will manage my behavior in a way that helps the instructor to be fun and safe for everyoneI understand that I will attend twice a week for one hour each day Student Signature Date
