My 3 Sons Tutoring

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My 3 Sons Family Tutoring for the SATs and ACTs

If you are trying to register using INTERNET EXPLORER, STOP! This form will not go through properly. Try using Google Chrome or Firefox instead.

Student Information:*

2.	Please choose the school/district your child attends.*
	Please choose the school/district your child attends.* Roxbury High School / Roxbury Other, please specify school / district / state

4.	Please list any special accommodations needed for your child to be successful in our program.

5.	Method of Payment:* Please submit this form. If paying via check/cash, please send payment and make checks payable to the Roxbury Community School (42 North Hillside Avenue, Succasunna, NJ 07876). Please write "My 3 Sons" in the memo line. Payment is needed within one (1) week of registering. Instructors cannot accept payment. Credit card payments can be made on the next screen.
	Method of Payment:* Please submit this form. If paying via check/cash, please send payment and make checks payable to the Roxbury Community School (42 North Hillside Avenue, Succasunna, NJ 07876). Please write "My 3 Sons" in the memo line. Payment is needed within one (1) week of registering. Instructors cannot accept payment. Credit card payments can be made on the next screen.Cash Check/Money Order Credit/Debit Other, please specify

6.	If paying via check/money order, please enter check number here. Please mail your check/money order to the Roxbury Community School at 42 North Hillside Avenue, Succasunna, NJ 07876. Please make checks payable to the Roxbury Community School and write "My 3 Sons" in the memo line.

Parent/Guardian Information:*
At least one parent/guardian information is required.

Parent/Guardian Information:
At least one parent/guardian information is required.

Emergency Contact Person*

Student Medical Information:*

Known Medical Condition of Participant:
Treatment/Medication Participant is Taking:
Physician's Name:
Physician's Phone:
Physician's Address:

11.	MEDICAL DISCLAIMER: For participants needing to self-administer medication, please send in a doctor's note to the Community School. The only medication that can be self-administered are an EPI Pen and/or an inhaler. A school nurse will not be present during these workshops. In case of an emergency, students will be transported to the nearest medical facility and parents will be contacted. Students and parents agree to abide by all Roxbury School District regulations. The Roxbury Township Board of Education assumes no liability.*

12.	Behavior Issues: Roxbury Community School reserves the right to dismiss a child from the program because of behavioral issues. No refunds will be issued.*

13.	DISCLAIMER/REFUNDS: A receipt may not be given when registering. You may assume your registration has been received unless notified. There are no refunds once the program starts. All cancellations must be received in writing at least seven days prior to the start of the class for a refund. Participation in Community School activities are at your own risk and no medical personnel will be on duty during this program. The Roxbury Township Board of Education assumes no liability. To read the full Roxbury Community School policy, please visit www.roxbury.org/RCSPolicies.*

14.	SOCIAL MEDIA: During Community School programs, arrangements are made to take pictures, video, or live-post to social media sites. School personnel, a media student or a newspaper photographer may obtain content for use in local media, on the district website, student publications/outlets to showcase the wonderful things happening within the district. The participant's name may be included, especially in a caption of a picture containing their likeness. By completing this form, participation is implied.*

16.	Would you like to be added to the Roxbury Community School email contact list announcing different programs and trips?