New Beginnings' Virtual Tutoring 2021-2022 School Term

Virtual Tutorial Services 2021-2022

Please complete the form below if you want your child(ren) to receive one-on-one tutoring on-line.
Parent/Guardian's Name:

First NameLast NameSuffix (Jr, Sr, II)
Parent/Guardian's Contact Number:
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian's Email:
example@example.com
How many of your children do you want to sign-up for one-on-one tutoring on-line?

Child's Information

Please be reminded that all children receiving virtual tutoring must be signed up for New Beginnings' tutorial services.
Child #1 Name:

First NameLast Name
Child #1 Gender:
Child #1 Birthdate:

MonthDayYear
Please enter your child's birthdate.
Child #1 Grade:
Child #1 School's Name:
Child #1 S9 Number:
Which subject does Child #1 need help with?

Other
Child #1 Comments:
Child's #2 Name:

First NameLast Name
Child #2 Gender:
Child #2 Grade:
Child #2 School's Name:
Child #2 Comments:
Child #2 S9 Number:
Which subject does Child #2 need help with?

Other
Child #2 Comments:
Child #3 Name:

First NameLast Name
Child #3 Birthdate:

MonthDayYear
Please enter your Child #2 birthdate.
Child #3 Gender:
Child #3 Grade:
Child #3 School's Name:
Child #3 S9 Number:
Which subject does Child #3 need help with?

Other
Child #3 Comments:
Child #4 Name:

First NameLast Name
Child #4 Gender:
Child #4 Birthdate:

MonthDayYear
Please enter your child's birthdate.
Child #4 Grade:
Child #4 School's Name:
Child #4 S9 Number:
Which subject does Child #4 need help with?

Other
Child #4 Comments:
Child #5 Name:

First NameLast Name
Child #5 Gender:
Child #5 Birthdate:

MonthDayYear
Please let us know your child's birthdate.
Child #5 Grade:
Child #5 School's Name:
Child #5 S9 Number:
Which subject does Child #5 need help with?

Other
Child #5 Comments:
Child #6 Name:

First NameLast Name
Child #6 Gender:
Child #6 Birthdate:

MonthDayYear
Please let us know your child's birthdate.
Child #6 Grade:
Child #6 School's Name:
Child #6 S9 Number:
Which subject does Child #6 need help with?

Other
Child #6 Comments:
Child #7 Name:

First NameLast Name
Child #7 Gender:
Child #7 Birthdate:

MonthDayYear
Please let me know your child's birthdate.
Child #7 Grade:
Child #7 School's Name:
Child #7 S9 Number:
Which subject does Child #7 need help with?

Other
Child #7 Comments:
Child #8 Name:

First NameLast Name
Child #8 Gender:
Child #8 Birthdate:

MonthDayYear
Please let us know your child's birthdate.
Child #8 Grade:
Child #8 School's Name:
Child #8 S9 Number:
Which subject does Child #8 need help with?

Other
Child #8 Comments:
Child #9 Name:

First NameLast Name
Child #9 Gender:
Child #9 Birthdate:

MonthDayYear
Please let us know your child's birthdate.
Child #9 Grade:
Child #9 School's Name:
Child #9 S9 Number:
Which subject does Child #9 need help with?

Other
Child #9 Comments:
Child #10 Name:

First NameLast Name
Child #10 Gender:
Child #10 Birthdate:

MonthDayYear
Please let us know your child's birthdate.
Child #10 Grade:
Child #10 School's Name:
Child #10 S9 Number:
Which subject does Child #10 need help with?

Other
Child #10 Comments:
Acknowledgement
Please read the following statement and click on the box provided if you agree with the terms:

I hereby grant permission for my child(ren) to receive any medical attention deemed necessary by New Beginnings' staff, their partners and/or volunteers for injuries or sickness that occur during Program sponsored activities. I will be responsible for any and all medical costs. I will not hold New Beginnings' staff, partners or volunteers liable for any injury or damage received by my child(ren) while transported or while engaging in Program sponsored activities.
Parent/Guardian's Signature:
Today's Date

MonthDayYear
Please enter today's date.Hour/MinutesAM/PM Option
Should be Empty:

Virtual Tutorial Services 2021-2022

Child's Information

Acknowledgement