2025-2026 Year @ Glance Registration

Please accurately and completely fill out all the information below. All information will be kept private and will only be used for Rize Over Run LLC and the State of Florida Non-Discrimination Reporting and Monitoring purposes.

Student Last Name:

Student First Name:

Date of Birth:

Month

Day

Year

Sex

Male

Female

Grade for 2025-2026 school year:

Student district school number:

Student phone # 000-000-000:

Home address:

Parent or guardian name:

Parent's email:

Person to reach in case of emergency:

Phone # for emergency contact:

Current school attending:

Has this student been retained?

Yes

No

Does your child have individual learning plan or any learning plan?

Yes

No

If answered yes to the last question, explain:

Student Current Math FAST Level? *If applicable

Student Current ELA FAST Level? *If applicable

What do you expect by the end of this program?

Is this your first time in a tutoring program?

Yes

No

I understand that clicking this button is an electronic signature. Your child will then be registered for Rize Over Run LLC Year @ Glance 2025-2026 tutoring program.

I have double checked this application for truth and accuracy.