New Tutorial Registration

Parent/Guardian Information
Parent Full Name

Parent First NameParent Middle NameParent Last Name
Age
Birth Date*

MonthDayYear
Relationship to student
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone Number
Cell Phone Number
Work Phone Number
E-mail*
example@example.com

Emergency Contact & Authorized Pick-Up Information
Contact #1

First NameMiddle NameLast Name
Relationship to Student
Home Phone Number
Cell Phone Number
Work Phone Number
Contact #2

First NameMiddle NameLast Name
Relationship to Student
Home Phone Number
Cell Phone Number
Work Phone Number

Your Selected Program Tuition
Currency
Total Cost
Total Cost
${totalCost} per month

Payment is required before tutorial sessions begin.

Review:

Class Size: {areYou347}

Time Commitment: {timeCommitment}{groupTime}

Location: {sessionLocation}

Subject(s): {subjectOf}

{additionalSubject}
Tuition Agreement*

Yes, I'd like to proceed.
Institution Pay
By selecting "Yes, I'd like to proceed" on Tuition Agreement, you are declaring that tutorial services will be paid for by the institution entered on the previous page. Please note that if we do not have prior authorization, we will be contacting the institution to verify. Tutorial sessions will not be scheduled or confirmed without authorization from the institution responsible for payment.

If at any point the institution contacts ACLC Tutoring to cease tutorial services, payment for tutorial services rendered until the date of cancellation will be the responsibility of the institution. However, if the student or parent/guardian wishes to continue tutoring, payment will be the responsibility of the student (if the student is over 18) or parent/guardian (if the student is under 18).
Tuition Agreement*

Yes, I'd like to proceed.
Terms and Conditions (last revision date 08/20/2020)

Please read these Terms and Conditions carefully before confirming your agreement to it.
- All students are required to arrive on time for each session, as there are other students scheduled after them. If a student will not be able to attend a session, a minimum of 12 hours’ notice of absence is required. Students should be picked up no later than 10 minutes after a session ends. In case of an emergency please call.
- Students are expected to complete and turn in all homework assignments. The student should work independently, as much as possible, on their assignment(s). This helps the tutor assess the student’s progress.
- The student’s areas of strength and weakness will be assessed initially through a diagnostic exam. The student’s report card and Individual Education Plan (IEP) will also be used in the assessment process. A letter will be sent to the student’s teacher to obtain his/her input on the student’s areas of strengths and weaknesses. During the course of the year, tests will be given to assess the student’s progress. Parent/Guardian will be informed about their child’s progress.
- Failure to provide a minimum of 12 hours’ notice of absence will result in 1hour (for 2-hour sessions) or 45 minutes for a 90 minutes session being forfeited.
- This registration form must be completed in full with the correct information for each student. Please be sure to include any other applicable paperwork – income verification, allergy documentation, IEP, etc.
- The full tuition payment must be received a week prior to the program starting.
- There will be no refunds for missed days.
- ACLC customers cannot hire an ACLC tutor to tutor themselves or their child(ren). If you would like the tutor to continue tutoring you or your child, you must do so through ACLC.
- ACLC reserves the right to withdraw any child when, in the director's judgment, the child’s and/or family's behavior interferes with the rights and/or safety of others, the smooth functioning of the program, or violates the program's principles of conduct.
- I understand that it is my responsibility to bring any special concerns about my child to the director's attention upon registration.
- During the program, staff members and/or professional photographers take photos and videos for marketing purposes which may include the child(ren) listed on this registration form. Parents/guardians may refuse any or all commercial use of photos and videos related to specific children, provided that a written request is received by the director prior to the start of the program.
- By accessing or using our tutoring service you agree to be bound by these Terms & Conditions. If you disagree with any part of the Terms & Conditions, please bring it to our attention.
Credit/Debit card/bank account used for payment of tutorial service may be amended at any time by informing ACLC at least 48 hours prior to the payment due date. Payment for all tutorial services is due by the 1st of every month unless otherwise stated. If an alternate form of payment is not provided within 3 days prior to the due date, then your credit/debit card/bank account on file will automatically be charged for tutorial services.
Check this circle if you are over 18 years old. (If you are the student that will be receiving ACLC’s educational services, you don’t need to answer the permission to leave premises.)

I'm over 18 years old
Permission to leave Premises
$
Private Tutoring Payment Method*

Via Postal MailVia TelephoneIn Office
Payment Method*

Institution
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Student Registration Information

Parent/Guardian Information

Emergency Contact & Authorized Pick-Up Information

Customize Your Program

Your Selected Program Tuition

Institution Pay