H.O.P.E Learning Summer Building Session Intake Form
Welcome to H.O.P.E Learning Tutorials, LLC! Please complete the form to provide information about your child to assist us in developing a tutoring plan.
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Email *
Child's Name: *
Grade: *
Parent/Guardian's Name:
Phone Number: *
Emergency Name and Phone Number: *
Strategy Session Needed *
Required
Which days of the week work best for sessions? Please select all that apply!
Media Release: *
By checking this box, I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs, movies, or video tapes of the participant named above. I also grant the right to edit, use, and reuse said products for nonprofit purposes including use in print, on the internet, and all other forms of media by H.O.P.E Learning.
Is there anything  that you would like us to know about your child?  What subjects is your child struggling with?
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