Freedom City's Mentoring and Tutoring Enrollment Form
Please complete the form below to register your child for your mentoring and/or tutoring.
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Child's First Name: *
Child's Middle Name:
Child's Last Name: *
Child's Gender: *
Child's Ethnicity: *
Child's Date of Birth: *
MM
/
DD
/
YYYY
Name of Child's School *
Child's Grade: *
Child's Student ID Number *
Address: *
City: *
State: *
Zip Code: *
I would like to sign my child up for (Check all that apply): *
Required
Does your student have an IEP? *
When is your student available for tutoring? *
Morning
Afternoon
Evening
Monday
Tuesday
Wednesday
Thursday
Friday
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