Scholar Registration Form

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 2026-2027 school year:

Current school attending

Guardian's Name (First and Last)

Guardian's contact number

Guardians's email:

Home Address

Name of emergency contact

Phone number for emergency contact

Has this student been retained?

Yes

No

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

Yes

No

Student Current Math FAST Level? *If applicable

Student Current ELA FAST Level? *If applicable

What program(s) are you interested in?

Individual Tutoring

1 - Step Ahead: Summer Program

Homeschool: Tutoring & Guidance

What do you expect by the end of this program(s)?

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 Summer of 2026 1 Step Ahead Advancement program.

I have double checked this application for truth and accuracy.

Total Price of Service/s

$

Services offered

Homeschool Guidance Consult (1 hr.)$50

1-hour tutoring session$65