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HOURLY TUTORING

CHILDS DETAILS

First Name *

Last Name *

Date of Birth *

ID Number *

Grade *

Age *

Gender *MaleFemal

FATHER / GUARDIAN DETAILS

First Name *

Last Name *

Date of Birth *

ID Number *

Phone *

Email Address *

Street Address *

City *

ZIP / Postal Code *

MOTHER / GUARDIAN DETAILS

First Name *

Last Name *

Date of Birth *

ID Number *

Phone *

Email Address *

Street Address *

City *

ZIP / Postal Code *

BILLING INFORMATION

Please Note that upfront payment of 4 Weeks are required for Hourly Tutoring.

Is person responsible for payment of fees different from parents /guardian? *YesNo

First Name *

Last Name *

Date of Birth *

ID Number *

Phone *

Email Address *

Street Address *

City *

ZIP / Postal Code *

SIGNATURES

PARENTS / GUARDIAN

First Name *

Last Name

ID Number *

Date Signed *

Signature *

TUTORING SESSIONS NEEDED

Please Select the Amount of Hourly Tutoring Sessions Needed for a WEEK *1 Hour2 Hours3 Hours4 Hours5 Hours6 Hours7 Hours8 Hours9 Hours10 HoursR 100 Per Hour

Total For 4 Weeks

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