Student Information

Student Full Name

School

Birthday

Grade

Programs Previously Attended

Courses student has completed:

Does the student require any special accommodations to participate in the program?

Does your child have any allergies/intolerance to food, medication, or any other substances?

Parent Information

Parent Full Name

Parent Email

Parent Phone Number

Parent 2 Full Name

Parent 2 Email

Parent 2 Phone Number

Address

City

State

Zip Code

Emergency Contact Full Name

Emergency Contact Relationship

Emergency Contact Phone Number

Primary Doctor's Full Name

Primary Doctor's Phone Number

Authorized Person for Pickup (note: in addition to parents and emergency contacts)

How did you hear of us?

Advance notice of 4 weeks is required
$70 per class for OMT I-IV ; $100 per class for Prealgebra would be charged for prorated fees calculation.
A course fee (given online access to the course) of $200 would be deducted
A cancelation fee of $200 will be applied per course

Class Placement: Class placements would be based on the student's current knowledge, commitment and priorities. Student's current math level will be assessed. The assessment data of other students will not be shared with the parents. Registration process includes submission of Registration Form and full payment of invoice.
Class Timing: Please refer to each appropriate courses' logistics for information on class timing
Waiting list: We may have to place your child in the waitlist if we are unable to find spots in the most appropriate class.
Refund: Parents who wish to discontinue from RMXplore before the end of the current session would need to provide a written advance notice. The tuition paid would be prorated for each class.
Fee & Registration: Please refer to each appropriate courses' logistics for information on course fee and registration process.

RMXplore is a fee-for-service program based on confirmed enrollments and secured deposits. In order to reserve your child(ren)’s spot, full payment must be received for each child and session you are registering for. Student(s) would need to take an assessment before placement can be confirmed.
I HAVE CAREFULLY READ THE RMXPLORE CLASS POLICIES. MY SIGNATURE BELOW INDICATES COMPLIANCE WITH RANDOM MATH POLICIES. I SIGN IT FREELY AND VOLUNTARILY.
Parent or Guardian - You will be required to review and sign the registration form on the first day of the session.

Parent or Guardian Signature

DateI agree to receiving marketing and promotional materials.

Thank you! Your submission has been received!

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