TUTORING REGISTRATION

Please complete the form below. There is a MANDATORY parent/child orientation for registration. Someone will contact you after registration with more details.

Student Name

First Name

Last Name

Student's Phone Number

(###)

###

####

Date of Birth

YYYY

Grade

Gender

School & District

Student's Email (if applicable)

Parent/Guardian Name

Parent's Email

Parent's Phone Number

(###)

###

####

Will you be attending?

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Does child have any known learning challenges?