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YOUR CHOICE OF LIVE ONLINE TUTORING OR ONE-ON-ONE IN THE COMFORT OF YOUR HOME

SINCE 2003

Sign-Up Form for Quality Tutoring Services

Note: This form contains two parts: Student Information and Parent Information. Students 18 years or older may fill out the Student Information section only. For students under 18 years of age, the Parent Information section is required.

Student Information:

* Indicates required field

Name of Student *

First

Last

Grade *

School *

Street Address *

How did you hear about us? *

Tutoring Preference *

Phone Number *

Email Address *

Student's Strenghths and Weaknesses *

Parent Information:

Note: This section is required for students under 18 years of age.

Select One: *

Dr. Mr. Mrs. Ms.

Enter title you prefer

Name of Parent *

First

Last

Address *

Phone Number *

City *

Fax Number *

Email *

What are you hoping the student will gain through tutoring? *

Are there any concerns we should be aware of? *

Billing Information: We accept different forms of payment, including cash or check (drop off only), credit/ debit (convenience fee), PayPal (convenience fee), Zelle, or Venmo. Please choose your preferred choice of payment below:

Forms of Payment *

Cash/ Check Credit/ Debit PayPal Zelle Venmo

Discounts Inquiry: Please click your preferred package below. To find out more information, please visit our Promotions page. For further questions or clarifications, please give us a call at 714.991.3836.

Promotion Packages *

Spin to Win: If you received a coupon code please share it below:

Coupon Code *

Disclaimer: Spin to Win coupon codes cannot be combined with other active promotional deals and programs. Coupon must be surrendered at the time of service. Clients from organizations and contracts are ineligible for coupons and promotional deals offered by Quality Tutoring Services.

Please read our Tutoring Policy and accept the terms below. By checking the box, you have agreed to the Tutoring Policy Terms and all it entails. For further questions or clarifications, please give us a call at 714.991.3838.

I accept the terms & conditions in the Tutoring Policy: *

Yes No

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