Tutoring Application for Enrollment
Tutoring sessions will be Tuesdays and Thursdays, after school until 5pm. Please pick up children at The Connection, 124 E Grand River, Laingsburg.
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Student's Full Name
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Student's Age
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Date of Birth
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DD
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Name of Parent or Guardian
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Parent email
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Address
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Phone Number
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School Attending
*
Teacher's Name
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Grade
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Please indicate in which area(s) help is needed for this child?  *
Any diagnoses that affect your child’s learning? *
Does your child have a food or other allergy?  If so, please list here *

If other than the above parent/guardian, give name and phone number (A photo ID will be required at pick up)

By clicking "agree" below, I confirm that I fully understand all of the above information, that I will contact The Connection at (517) 763-8313 if my child will miss a session, and that my child will be unable to attend if he or she proves to have a repeating behavioral problem.

I agree to indemnify and hold harmless The Connection from any claims, demands, or actions arising out of or related to my child during tutoring sessions, including but not limited to, property damage, personal injury, or loss of belongings.

I acknowledge that I have read and understood the terms of this waiver, and I voluntarily agree to its contents.

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