Student Registration

IMPORTANT: After registering, please wait for an approval email before booking.

Please complete the student registration form below. This information allows us to review enrollment and ensure we are able to best support your child. After registration has been reviewed and approved via email, families may move forward with scheduling tutoring sessions.

Open Heaven Academy Registration Form

Student Information

First Name*

Last Name*

Birthday*

Month

Day

Year

Gender*

Grade Level*

School Name*

Type of School*

Public

Private

Charter

Parent/Guardian Information

First Name*

Last Name*

Relationship to Student*

Email*

Phone*

Address*

Tutoring Details

Subject(s) Needed*

Reading

Writing

Math

Science

Other

Learning Goals (please describe the areas your child needs help with):*

Additional Information

Does the student have an IEP or special learning needs?*

If yes, please explain

How did you hear about us?

Referral

Social Media

School

Other

I understand that all registrations are reviewed and must be approved before I book services for my child/children.

info.oha@yahoo.com | (813) 213-9637

4626 Pipkin Road South, Lakeland, FL 33811

Home
Registration
Book Services

bottom of page