Student Registration Form

Student Registration Form

Student Registration Form
Tuition Co.
Student Information
Name

First NameLast Name
Birth Date

DayMonthYear
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Gender
Phone Number
Can we contact this phone number?
Email Address
example@example.com
Year Level
Subject
School Attended
Are we allowed to take photo of you and publish them on our Social Media?
Current Residence Information
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Residence Information (if different from above)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact 1
Name

First NameLast Name
Phone Number
Mobile Phone
Email
Email of Parent - For payments and subscription to our newsletter
Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.

Notes
Terms and Conditions

1. A signed registration form and initial payment is required for services to begin.

2. Payments are not made to the tutor. Please consult with the office.

3. If a rescheduling has to be made, please do not approach the tutor. Please consult with the office.

4. Cancellation Policy: Cancellation of classes MUST be done 24 hours prior to the scheduled class. Late notices will be charged.

5. Payments are made on a monthly basis upfront.

6. Termination of credited classes will not be refunded. However, classes can be attended to finish the remaining credits.

7. Failure to attend 5 weeks of classes will result in the termination of classes and have to be rescheduled (Unless the office has been consulted with a legitimate reason. Holidays are not included).
I, blanks accept the terms and conditions.
Signature
Should be Empty: