Parent Name:
Student Name:
Email Address:
Daytime Phone:
Evening Phone:
Street Address:
City:
Zip Code:
Program of Interest:
----- Please select -----
After school: (3:30PM to 6:00PM)
After school: (12:00AM: to 6:00PM)
Summary programs
Preferred Day and Time (Private Classes Only):
Any
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Any
1:00-2:00pm
2:00-3:00pm
3:00-4:00pm
4:00-5:00pm
5:00-6:00pm
6:00-7:00pm
7:00-8:00pm
8:00-9:00pm
9:00-10:00pm
Preferred Start Date:
Student Age:
Message to Kwan Academy, if any:
Additional Questions:
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