Tela-Tutors Student Registration Form

Tela- Tutors Online Student Registration Form

New Student Intake

Student Educational History-
Parent's Full Name *
Relationship*
ex. Father, Mother, etc.
Child's Full Name*

First NameMiddle NameLast Name
Grade Level*
Current Grade Level
Enrollment Program
Choose your Group Size
Parents E-mail*
Parent's Telephone Number*
Child's Birth Date*

MonthDayYear
Present Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Current School Name*

Academic Background
Does your child have any ailments or disabilities that we should be aware of while working together?

What goals would you like us to work on child?
Other Skills/Hobbies
Interests*
Would you be interested in a student assessment?
Yes or No
Suggestions / Comments
Enter the words shown:*
Should be Empty: