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Tutoring Registration Form
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Email
*
Your answer
Name/Relationship of person completing the form
*
Your answer
Phone number
*
Your answer
Address (complete)
*
Your answer
Student Information
All questions in this section are about the student you are registering.
Name
*
Your answer
Date of Birth/Age
*
Your answer
Current grade level
*
Your answer
Does student have an IEP or 504 plan? Please explain.
*
Your answer
Student's email address (personal google email needed for Google Classroom)
*
Your answer
Emergency contact/name
*
Your answer
Emergency contact number
*
Your answer
Subject and Grade Level that student will be tutored in:
*
Your answer
Additional Information that we should know (struggles, strengths, specific tutoring goals):
Your answer
Days and times that student is available for tutoring?
*
Your answer
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