SCA SUMMER TUTORING PROGRAM 2023
JUNE 26TH - SEPTEMBER 16TH
Application and Registration Form
Small Group classes meet twice per week -totaling 2 hours per week
Date
-
Month
-
Day
Year
Date
Student's Name
First Name
Last Name
Student's Date of Birth
-
Month
-
Day
Year
DOB
Student's Age
Age in Fall of 2023
Grade entering in Fall of 2023
Gender
Primary Language Spoken at Home
Is the student Right or Left Handed?
Is your child a current or former SCA student?
Please Select
Current SCA student
Former SCA student
New Student
Were you referred to us by your child's school?
Please Select
Yes
No
Has your child been retained this school year?
Please Select
Yes
No
Has your child been enrolled in a speech/language therapy program?
Please Select
Yes
NO
Does the student have an IEP?
Please Select
Yes
No
Any diagnosis that affects your child’s learning? If so, please explain. If no, please type N/A
What is your expectation of the Summer Tutoring Program?
How did you hear about us?
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Does your child require a verification letter of completion of our program?
Please Select
Yes
No
Choose the desired class below.
Please select the program of interest:
Summer One on One Tutoring 6 week program
Summer One on One Tutoring 8 week program
Summer One on One Tutoring 10 week program
Small Group Reading Program 6 weeks
Small Group Reading Program 8 weeks
Small Group Reading Program 10 weeks
Small Group Math Program 6 weeks
Small Group Math Program 8 weeks
Small Group Math Program 10 weeks
Small Group Reading & Math Program 6 weeks
Small Group Reading & Math Program 8 weeks
Small Group Reading & Math Program 10 weeks
Let's Get Ready For Kindergarten 6 weeks
Let's Get Ready For Kindergarten 8 weeks
Let's Get Ready For Kindergarten 10 weeks
High School Preparation 6 weeks
High School Preparation 8 weeks
Small Group Classes are scheduled Monday- Thursday between 1:00 pm-3:00 pm and 5:00 pm-7:00 pm (one hour per class - twice per week). Saturday group class are scheduled between 9:00 am-11:00 am. Please list preferred days and times. Please be as flexible as possible. The SCA will match your child with best available class according to your available days and times. Please also list days that your child is unavailable. One-on-one session schedules are flexible and will be confirmed upon registration. Dates and times are subject to change.
My Products
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( X )
One on One tutoring 6 weeks
2 x per week + $49 registration
$
673.00
Quantity
1
2
3
4
5
6
7
8
9
10
One on One tutoring 8 weeks
2x per week + $49 registration
$
881.00
Quantity
1
2
3
4
5
6
7
8
9
10
One on One tutoring 10 weeks
2x per week + $49 registration
$
1,089.00
Quantity
1
2
3
4
5
6
7
8
9
10
Small Group Class 6 Weeks
2 x per week + $25 registration - this includes reading, math, kindergarten preparation prorams.
$
505.00
Quantity
1
2
3
4
5
6
7
8
9
10
Small Group Class 8 Weeks
2 x per week + $25 registration - this includes reading, math, kindergarten preparation programs.
$
665.00
Quantity
1
2
3
4
5
6
7
8
9
10
Small Group Class 10 Weeks
2 x per week + $25 registration - this includes reading, math, kindergarten preparation programs.
$
825.00
Quantity
1
2
3
4
5
6
7
8
9
10
High School Preparation Program 6 weeks
2 x per week +$25 registration
$
565.00
Quantity
1
2
3
4
5
6
7
8
9
10
High School Preparation Program 8 weeks
2x per week + $25 registration
$
725.00
Quantity
1
2
3
4
5
6
7
8
9
10
Back
Next
Name of Person Completing the Form
First Name
Last Name
Relationship to Child
Please provide the name of the person responsible for registering the student into the summer program. This person will be our primary contact person as well as the person responsible for the financial responsibility associated with registration. .
Relationship to Child
Mother's Name
Mother's First Name
Mother's Last Name
Mother's Date of Birth
-
Month
-
Day
Year
Date
Mother's Phone Number
Please provide the primary contact number
Mother's Email Address
Father's Name
Father's First Name
Father's Last Name
Father's Date of Birth
-
Month
-
Day
Year
Date
Father's Phone number
Please provide the primary contact number
Father's email address
Does the student have siblings? If yes, please list below. If no, please type N/A.
Back
Next
Registration is not complete until payment is received. All fees, deposits or payments received are non-refundable.A minimum of 24 hours notice is required to reschedule a tutoring session.SCA will be closed on 7/3, 7/4, 9/4, Any sessions scheduled for these days will be made up.
Which week will your child begin the tutoring program?
I understand and agree with all terms listed above and affirm that all provided information is accurate.
Clear
Submit
Pay with Credit Card
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
My Products
prev
next
( X )
One on One tutoring 6 weeks
2 x per week + $49 registration
$
673.00
Quantity
1
2
3
4
5
6
7
8
9
10
One on One tutoring 8 weeks
2x per week + $49 registration
$
881.00
Quantity
1
2
3
4
5
6
7
8
9
10
One on One tutoring 10 weeks
2x per week + $49 registration
$
1,089.00
Quantity
1
2
3
4
5
6
7
8
9
10
Small Group Class 6 Weeks
2 x per week + $25 registration - this includes reading, math, kindergarten preparation prorams.
$
505.00
Quantity
1
2
3
4
5
6
7
8
9
10
Small Group Class 8 Weeks
2 x per week + $25 registration - this includes reading, math, kindergarten preparation programs.
$
665.00
Quantity
1
2
3
4
5
6
7
8
9
10
Small Group Class 10 Weeks
2 x per week + $25 registration - this includes reading, math, kindergarten preparation programs.
$
825.00
Quantity
1
2
3
4
5
6
7
8
9
10
High School Preparation Program 6 weeks
2 x per week +$25 registration
$
565.00
Quantity
1
2
3
4
5
6
7
8
9
10
High School Preparation Program 8 weeks
2x per week + $25 registration
$
725.00
Quantity
1
2
3
4
5
6
7
8
9
10
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