Student Intermediate Registration – Winter 2024

MemberPress Student Intermediate Registration setup page. January 2024

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Student First Name:* Student First Name is Required

Student Last Name:* Student Last Name is Required

Grade in School:* Grade in School is Required

Is your child currently receiving special services in school? (check all that apply): Is your child currently receiving special services in school? (check all that apply) is not valid

Title 1 Reading Support Special Education Other

If other please explain: If other please explain is not valid

Is your child currently being tutored?:* Is your child currently being tutored? is Required

Yes No

What are your child's strengths in school?: What are your child's strengths in school? is not valid

What are your child's challenges in school?: What are your child's challenges in school? is not valid

Please add any other information that would help teachers as they tutor your child.: Please add any other information that would help teachers as they tutor your child. is not valid

Child Attending an Immersion Program?: Child Attending an Immersion Program? is not valid

Yes No

Phone:* Phone is Required

How did you hear about Orton Gillingham MN?:* How did you hear about Orton Gillingham MN? is Required

Username:* Invalid Username

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

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Description	Amount
Student Intermediate Registration - Winter 2024 – Payment	$200.00
Total	$200.00

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