Registration Form:Please enable JavaScript in your browser to complete this form.Enter Student's First and Last Name *Please enter first and last name.School *Date of Birth *Grade *Student's Current Grade LevelPre-KKindergarten1st2nd3rd4th5th6th7th8th9th10th11th12thFull Home Street Address and City *Enter street address, apartment if applicable, city, and zip code.Zip Code *Enter street address, apartment if applicable, city, and zip code.State *AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingEmail *EmailConfirm EmailHome PhoneIf applicable.First Parent or Guardian's Name *Please enter first and last name.First Parent or Guardian's Cellphone Number *First Parent or Guardian's Work NumberSecond Parent or Guardian's Name *Please enter first and last name.Second Parent or Guardian's Cellphone Number *Second Parent or Guardian's Work NumberEmergency Contact Name (other than parents') *Please enter first and last name of individual other than parents or guardians.Emergency Contact Number (other than parents') *Medical Conditions *Please state if the student has any medical conditions. Otherwise, enter N/A.Food Allergies *Please state if the student has any food allergies. Otherwise, enter N/A.IEP *Please state if the student has an IEP (Individualized Education Program). Otherwise, enter N/A.Going Out Alone *YesNoIs your child allowed to go out alone? (Chang Learning is not responsible for your child's saftey outside of our premises).Dismissal *My child will go home alone.My child will be picked up.Please note all students in grades 7 - 12 will walk out of Chang Learning by themselves.Please enter first and last name of individuals other than parents or guardians authorized to pick up your child.Photo Permission *YesNoDo you give permission to Chang Learning to take photos of your child, which may be used on flyers, websites, posters, and other material?Select programs *One-on-one TutoringHomework HelpELA and Math Test PrepWriting and ReadingSHSAT Prep - Grade 7WritingSHSAT Prep - Grade 8ELA & Math Test Prep BootcampSAT PrepSummer Classes Grades 1 - 7Summer SATSummer SHSATSelect the program(s) that your child is registering for.How did you hear about Chang Learning?Additional InformationList any additional information about your child you would like to inform us about.Digital Signature *Please enter your initalsToday's Date *NameSubmit© 2020 Chang LearningPrivacy PolicyTerms of Use