This form is for Fall 2024 courses at Irvine Math Academy.

Is your student attending for the first time?*

First Time
Continuing
Returning

Referral (If a friend or relative referred you, please specify the name.)*

Please let us know how you found us! (friend, advertisement, online etc.)

Courses*

Please place a check mark next to the course(s) you'd like to register for.

Fall 2024 Schedule

Mondays (9/9, 9/16, 9/23, 9/30, 10/7, 10/14, 10/21, 10/28, 11/4, 11/11, 11/18, 11/25, 12/2, 12/9, 12/16)

AP Calculus BC
(7:00 P.M. ~ 9:00 P.M.)

Sundays (9/8, 9/15, 9/22, 9/29, 10/6, 10/13, 10/20, 10/27, 11/3, 11/10)

Math Olympiads AMC 10

Thursdays (9/5, 9/12, 9/19, 9/26, 10/3, 10/10, 10/17, 10/24, 10/31, 11/7, 11/14, 11/21, 12/5, 12/12, 12/19)

AP Pre-Calculus
(7:00 P.M. ~ 9:00 P.M.)

Registration Form

Student's Legal First Name*

Student's Legal Middle Name

Optional

Student's Legal Last Name*

Nickname

If there is a preferred name you'd like to use, please let us know.

Student's Date of Birth*

Gender*

Male
Female

Home phone number*

Cell number

Street Address (please no P.O.BOX)*

Address Line 2

City*

State*

Zip Code*

Emergency Contact + Relationship*

Emergency Contact's number*

Current School*

Current Math Course at School*

Current Grade Level*

Student's Email

No naver or hanmail please. Please do not use parent's email here in this field. You can either use your child's email address or leave it blank.

Parent's Email*

Enter Email Confirm Email

(No naver or hanmail emails please)

Check below for email updates

Irvine Math Academy, LLC Policy and Attendance

Checking below indicates that my child and I agree to the following policy:*

All students are supposed to attend all the classes online. Therefore, attendance is the student’s responsibility. Students are expected to login on time and logout on time. There will be no make-up classes for the missed ones.
When students sign for the class(es) listed above, the tuition is supposed to be paid in full. There will be NO refund or adjustments in tuition for absences due to illness or schedule conflict or ANY other reason(No carry over for any reason or applying any credit from previous semesters). All tuition are supposed to be paid in advance in order for us to secure a spot for the student.
Evaluation of class size and other factors makes your placement in classes not guaranteed. Payment must be received within 7 days of the registration, otherwise the student will be removed from the class list.
You acknowledge that Irvine Math Academy, LLC is not a dependent care facility but is a tutoring program. Irvine Math Academy, LLC does not qualify for IRS Publication 530 tax deductions.

Confirmation

Payment Method*

Credit Card
Zelle

Total

$0.00

Credit Card

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Please note that ONLY U.S. credit cards and debit cards are allowed.

Coupon

Checks must be payable to:
Mohamad Youssef
15642 Sand Canyon Ave
Unit 54064
Irvine, CA 92619

Please pay with Zelle using this email address: [email protected]

Parent / Guardian's Name*

First Last

Signature of Parent /Guardian*

Signing above indicates that my child and I agree to the all policies listed in this form. I, the Parent/Guardian acknowledge class prices and provided accurate personal information.

Date Signed*

You have not selected a course. Please return to the top of the form and select at least one course. Otherwise, the registration will be invalid.

Please review all the information you entered below and then click next at the bottom of the page!

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