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Alpine Academy Enrollment Form
Tutoring Agreement
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* Indicates required question
Student's first and last name:
*
Your answer
School student attends:
*
BOES
CELC
JMMS
MVLA
SHES
Student's grade level:
*
TK
K
1st
2nd
3rd
4th
5th
6th
7th
8th
Dual Language families only: Would you like tutoring in English or Spanish?
English
Spanish (We cannot guarantee your child will receive Spanish tutoring)
Clear selection
Please share specific areas that you feel your student needs extra academic support.
Your answer
Parent/Guardian #1 name and phone number:
*
Your answer
Parent/Guardian #2 name and phone number:
*
Your answer
Emergency contact #1 name and phone number:
*
Your answer
Emergency contact #2 name and phone number:
*
Your answer
I agree that my child will attend on the designated days and times offered by the Alpine Academy. If my child misses three (3) days with out prior notification to the Lead tutor I understand my child may be moved to another day and time slot.
*
I agree (I agree this is my digital signature)
I have changed my mind and I would not like to proceed with the Alpine Academy at this time.
I decline services.
Clear selection
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