REGISTRATION FOR RLA PROGRAMS


Registration information will be submited by this form
Type in the information and press 'CLICK TO REGISTER'
Print the confirmation page and mail a $100 deposit payable to The Rutledge Learning Academy to:
Rutledge Learning Academy
PO Box 236
Jamison, PA 18929

Thank you! We look forward to the opportunity to work with your student! If any additional information is
required during the registration process, please feel free to call us at 215-343-9642.
Student’s Name Parent or Guardian
Grade (2012-2013 school year)
School (2012-2013 school year)
Home Phone #Parent’s Work Phone #
Parent’s E-mailStudent’s E-mail
Address
City, State, Zip,,
Which courses would you like to register for? (Please checkbox)
Algebra One Geometry
Algebra Two Pre-Calculus
SSAT Preparation Spring 2012 SAT Preparation in Bucks County
Summer 2012 SAT Preparation in Bucks County Fall 2012 SAT Preparation in Bucks County
Winter 2012 SAT Preparation in Bucks County Spring 2013 SAT Preparation in Bucks County
Spring 2012 SAT Preparation at Archbishop Ryan High School Fall 2012 SAT Preparation at Archbishop Ryan High School
Winter 2012 SAT Preparation at Archbishop Ryan High School Spring 2013 SAT Preparation at Archbishop Ryan High School

How did you learn about the
Rutledge Learning Academy?
Please note any special circumstances we should be aware or regarding your child’s learning.
Please list names, and grades of siblings of the child registering