Parent
Information: Dr.
Mr. Mrs.
Ms.
Full Name:
Address:
City: ZIP:
Phone (Hm):
Phone (Wk):
Cell: Fax:
Credit Card Information:
To help us with our billing, please call us with your credit card
information at (714) 991-3836 or (714) 991-3838. Please read our
Tutoring Policy.
I accept the terms & conditions in the Tutoring Policy. Yes:
No:
Questions for Parents:
What are you hoping the student will gain through tutoring?
Are there any concerns we should be aware of? |
Student Information:
Full Name:
Date of Birth:
School: Grade:
Phone: Cell:
Referred by:
Student's Strengths. What are the student's strengths in the
following areas:
Academic skills:
Organization skills:
Behaviour:
Weaknesses. What are the student's weaknesses in the following
areas:
Academic skills:
Organization skills:
Behaviour: |