Tutoring Registration Form

Full Name(Required)

Date of Birth(Required)

School(Required)

Grade Level(Required)

Full Name(Required)

Phone(Required)

Email Address(Required)

Emergency Contact Name & Phone

Address(Required)

Street Address City State ZIP Code

Tutoring Services Selection (Check all that apply)

Remedial Math

Remedial Reading

SAT Preparation

Please list preferred days and times for tutoring sessions:

Students are expected to come prepared with their materials.
Respectful behavior toward the tutor and other students is mandatory.
Parents will be contacted in the event of disruptive behavior.
Continued misconduct may result in the termination of tutoring services without refund.
Student MUST keep camera on at all times.

Personal devices (e.g. phones, tablets) may only be used for educational purposes during sessions.
Parents must inform us of any learning tools or apps the student is required to use.
All student data will be kept confidential and will not be shared with third parties.

Parents may withdraw their child at any time with a two-week written notice.
Pre-paid tuition for sessions not held after the withdrawal date will be refunded.

By signing below, you acknowledge that you have read and agreed to the policies outlined above.

Parent/Guardian Signature:(Required)

Date(Required)