Virtual Tutoring Enrollment Form

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Thank you for your interest in our program! Please fill out one registration form per child. The agreed-upon payment ($50.00 / 60 mins) for each tutoring session is due one week before the scheduled session. Upon receiving your payment for the first session, an email with further instructions will follow.

Child's Full Name *

Child's Date of Birth *

YYYY

Child's Gender *

Male

Female

Other

Child's Grade Level for 2021-2022 School Year *

Preschool (ages 3-4)

Pre-K (ages 4-5)

Kindergarten (ages 5-6)

First Grade (ages 6-7)

Second Grade (ages 7-8)

Does your child have any conditions that will affect play/learning? Please type YES or NO. If YES, please list conditions. *

Which days are you registering for tutoring? *

Additional Comments

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