Weston Town Center Executive Suites
1792 Bell Tower LaneWeston, FL 33326
			   www.flynnsat.com,  (954) 290-2787,  flynnsat@aol.com
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Student Name: _________________________________________________________________
GRADE: _____   D.O.B. ____/_____/_______    GENDER: ____   High School: __________________
Parent(s) Name(s): ______________________________________________________________
Parent(s) Email(s):  ______________________________________________________________
Student Email: _________________________________________________________________
Address: _____________________________________________________  Zip: _____________
Primary parent phone:   HOME: _______________________  CELL:   ________________________
Student cell phone (required for emergency contact):  _______________________________________
Highest Entering Scores:   __SAT  __PSAT:   Reading  _______  Math________ Writing _______
	(please provide a copy of all score reports  for 1st lesson, if possible)
Which class date/time are you registering for?  ___________________________________
Special request/concerns: ________________________________________________________
Current/Most Recent Math Class/Level:  ____________________   Your Grade in this class: ________
Current English Class 	Level:  ____ Regular  ___ Honors  ___ AP    Your Grade in this class: _______
Is test anxiety a problem for you? _____________    Weighted GPA _______    
Have you taken any previous SAT classes?  ______  With whom? ____________ Increase: _____________
Please let us know anyone specific who may have referred you to us so we may thank them:
Have you seen our ad media in:  ___ Weston Gazette?  ___ CBHS Newspaper? ___ Online Searches?   ___ Mailers
Please drop off (8:50am-5:10pm) or mail this form (with a $400 deposit) to the address above to secure your spot. Openings will be filled on a first-come, first-served basis.  All classes fill at  8 students. 
By signing below, I acknowledge that I have read and understood the “payments/policies” section on www.flynnsat.com, especially the sectionss about make-up lessons and the score guarantee.