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Student Information
2023 Summer Tutoring and Programs @ The Tutoring Center
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Tutoring Center Pricing -
all tutoring services will be prepaid on a monthly basis
Currently receiving Tutoring Services from
The Tutoring Center?
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Student Name
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Student Date of Birth
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Address
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Student Allergies and/or Medications
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Does your student have any relevant allergies? Does the student take any medications? If so, please list and give purpose.
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Parent/Guardian Name
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Parent/Guardian Email
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Parent/Guardian Phone Number
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Parent/Guardian 2: Name
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Parent/Guardian 2: Phone Number
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Are you willing to receive texts?
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Student Emergency Contact
Name and Phone Number if different from above
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