Raising the Bar Creative Concepts - Tutoring Services Registration

Parent First Name: *

Parent Last Name: *

Email: *

Telephone: *

Cell Phone:

Mailing Address: *

City, State, Zip Code: *

Responsible Party for Payment: *

Student's First Name: *

Student's Last Name: *

Student's Age: *

Student's Gender: *

School: *

Grade Level: *

Areas of Need:
Check all that apply

Organization & Study Skills Grades 6-12
Reading Grades 5-12
Writing Grades 5-12
English Grades 5-12
History Grades 5-12
Spanish Grades 5-12
Spelling Strategies
Math Grades 5-8
Parent Consultation(s) for Support and Strategies to Increase Student Success

Any Known Learning Disabilities:

List 3 Strengths & 3 Weaknesses
of the Learner: *

How did you hear about us?: *

If you answered other above, please specify:

Availability (days and times):
Check all that apply

Monday	Early Afternoon	Early Evening
Tuesday	Early Afternoon	Early Evening
Wednesday	Early Afternoon	Early Evening
Thursday	Early Afternoon	Early Evening
Friday	Early Afternoon	Early Evening
Saturday	Early Afternoon	Early Evening	Anytime
Sunday	Early Afternoon	Early Evening	Anytime

Comments:

Terms and Conditions:

By submitting this tutoring submission enrollment form, the parent or guardian agrees to the financial obligations and policies expressed below.

A one-time initial processing fee of $25 is due prior to receiving any tutorial placements. This fee will be returned if a placement in your area cannot be found. Tutoring services will be paid at the time of service and payments will be written directly to Raising the Bar.

Cancellation Policy:

Time is valuable to everyone. Cancellations not made (directly to your assigned tutor) at least 3 hours in advance of the tutoring session will result in a full charge for that session. This payment will be due the next session that is scheduled. Emergency situations excluded.

I agree to the terms noted above.

Agree.