Tutoring Registration Form
Today’s Date: _____________________
PERSONAL INFORMATION
Student Full Name: ______________________________________________________ M / F
Student’s Grade: __________________________ Subject: _____________________________
Email: _____________________________________________________________________________
Address: ___________________________________________________________________________
City: _________________________ State: _________________________ Zip Code: _______________
Emergency Contact: _____________________________ Relationship: __________________________
Day Phone: ____________________________________ Cell Phone: ____________________________
PROGRAM INFORMATION
Desired Time / Day: ___________________________________________________________________
Alternate Time / Day: __________________________________________________________________
Tutoring Fee: _________________________________________________________________________
PAYMENT INFORMATION
Card Number: _________________________________________________________________________
Exp Date: _______ / ______ / ________ Verification # __________________________________
Name on Card: ________________________________________________________________________
Signature: ____________________________________________________________________________
Full Billing Address: ___________________________________________ Zip Code __________________
CANCELLATION POLICY
Cancellation Of Lessons By Client/Student
The Client/Student may cancel tuition/lessons by giving at least 24 hours prior notice to the Tutor in
which case no tuition fees will be incurred. Lessons not attended by the student without giving 24 hours
prior notice to the Tutor shall be charged at the full rate.
Cancellation Of Lessons By Tutor
The Tutor may cancel lessons by giving 24 hours prior notice to the Client/Student in which case no fees
shall be incurred. Where a lesson was pre-paid, the Tutor shall reschedule the appointment at a time
agreeable to both parties, failing which the Client/Student shall be refunded with such a missed lesson
fee.
Refund Policy
Please be aware that we have a No Refund Policy for all services. Refund requests, including, but not
limited to, those made by Students who cannot attend or use services, regardless of the student’s
reason(s), and regardless of whether the Student provides us with advance notice, will not be honored.
Should you choose to cancel a prepaid Learning Package after attending your first session, you will be
billed for the remaining amount of the Tutoring Package price. Exceptions may be made only in cases in
which a Student cannot attend due to serious illness or the death of an immediate member of the
Student’s family. In these cases, official documentation may be required.
Obligations Of The Student
• The Student undertakes to assist the Tutor in identifying problem areas in which the Student
needs specific tutoring.
• The Student agrees to be prepared for every session by having all materials, utensils, homework,
etc. ready and available in the designated tutoring location prior to the Tutor arriving.
• The Student agrees that assignments, exercises or homework form an integral part of tutoring
and undertakes to complete such work timely.
Obligations Of The Parent/Guardian
• The parent/guardian undertakes to be responsible for the student’s conduct and character
during the tutoring sessions including promptness, respectful behavior, and staying on task.
• The parent/guardian is responsible for initiating any communication with the tutor.
• The parent/guardian is responsible for getting the student to the session on time and for picking
up the student promptly as soon as the session has ended.
• The parent/guardian agrees to ensure that the student has completed all work assigned by the
tutor within the timeframe given.
Student Signature: ________________________________________ Date: ______________________
Parent / Guardian Signature: ________________________________________ Date: _______________
