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Program
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Instructor
Contact
Forms
Enrollment Form
STUDENT ENROLLMENT FORM
Please fill out this form prior to your child’s introductory session.
Student Name
*
Student's Grade
*
(During summer, please use the grade your student will be entering in the fall.)
Kindergarten
Ist Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Mother's Name
First Name
Last Name
Father's Name
First Name
Last Name
Other Guardian's Name
First Name
Last Name
Other Guardian's Relation
(if applicable)
Contact Information
Mobile Phone
*
(This phone number will be used as the primary point of contact.)
(###)
###
####
Home Phone
(###)
###
####
Email Address
*
Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Academic Information
Student's School
*
Student's School District
*
Areas of Concern
*
(Please mark all that apply.)
Reading Skills
Math Skills
Writing Skills
Study Skills
Enrichment
Area of Greatest Concern
*
(Please choose only one.)
Reading Skills
Math Skills
Writing Skills
Study Skills
Enrichment
Areas of Concern Not Listed
Please list any concerns you may have that are not included above.
Enrollment Agreement
Consistent Schedule and Academic Focus
*
I understand that consistency is one of the most important factors in determining the success of my child's tutoring. I will do my absolute best to keep my child's tutoring schedule consistent and to maintain a consistent focus on the predetermined academic areas that have been targeted for improvement.
Cancellations and Makeups
*
If my child cannot be present for their regularly scheduled tutoring session, I agree to contact my child's tutor and cancel my child's session at least 3 hours in advance in order to receive credit for a makeup session. I understand that makeup credits do not expire and can be used during any available time slots. I also understand that makeup credits will not be given for "no shows" or sessions that are missed without advance notice.
Holidays and Vacations
*
I understand that tutoring is not available on Thanksgiving Day or during Winter Break but is open for all other holidays throughout the year and is not affected by the school district's holiday schedule.
Advance Payment Discounts
*
I understand that I may choose to pay my tuition 6 months in advance and will receive a 10% discount for doing so. I also understand that advance payments are non-refundable but may be transferred to another student if necessary.
Tutoring Materials
*
I understand that my child's tutor will provide all of the supplemental materials (workbooks, flashcards, etc.) needed to administer my child's program. I also understand that I am responsible for providing any additional materials that I feel are necessary to my child's program or that are only available through my chlid's school.
Tutoring Workspace
*
I understand that my child's tutoring will be the most effective in a clean, clutter-free and quiet workspace that is free of distraction.
Tuition and Refunds
*
I understand that there will be no refunds for missed sessions (unless cancelled by the instructor) but that I will receive makeup session credits for any cancellations. I also agree to pay my tuition at the start of each month, and I understand that my child's tutoring may cease if my tuition payment is not received in a timely manner.
Tuition Payment Options
*
(A PayPal account is not required to pay your invoice.)
Monthly Invoice via PayPal
6 Month Advance Payment via PayPal
6 Month Advance Payment via Check
Email Address for Billing
(if different from primary email address listed above)
Enrollment Agreement E-Signature
*
I fully understand and agree to the contents of this enrollment form, and I hereby authorize One2One to bill me via the payment method selected above.
First Name
Last Name
Today's Date
*
MM
DD
YYYY
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