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    • United States
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    For offices with restrooms outside the office, it is our policy that students in Pre K through 4th grade go to the restroom with an adult and recommend that students in 5th or 6th grade are accompanied by someone.
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    By clicking 'YES', you are acknowledging that you are permitting your student the ability to sign her/himself out of Middle Tree's supervision at your student's discretion to go off campus and into the area to get food/snacks. Middle Tree assumes no liability for your student's actions while off campus, and you agree to indemnify, hold harmless, and defend Middle Tree for any actions that result in property damage or injury, up to and including death, while your student has signed her/himself out of Middle Tree.
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    (MUST BE 18 years old or older)
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    • Uncle or Aunt
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    Please use FULL LEGAL name.
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    Signature Programs

    Foundations ($100 Pledge/Monthly)

    Unlimited study hall time with guidance from trained academic professionals. Your student can come at any time during specified operating ours. This is a group setting with students in a similar age group as your student.

    Growth ($160 Pledge/Monthly)

    Everything in Foundations, plus: four hours of dedicated individualized 1:1 tutoring and an opportunity to explore one class per month of our Enrichment Program*

    Summit ($250 Pledge/Monthly)

    Everything in Foundations and Growth, plus: four additional hours of dedicated individualized 1:1 tutoring, an opportunity to explore two classes per month of our Enrichment Program*, and our College Prepatory Program*

    Enrichment Program

    If your student is enrolled in ANY of our Signature Programs, each Enrichment Class not included in your pledge will be an additional $20 investment. 

    Packages

    Enrichment Tier One - Three Enrichment Classes a Month ($90/month)

    Enrichment Tier Two - Six Enrichment Classes a Month ($180/month)

    Enrichment Tier Three - Nine Enrichment Classes a Month ($270/month)

    College Support Program

    College Support Package: Two strategy sessions; one focused on college applications and the second focused on financial aid. Bonus: Two study sessions  ($100/package)

     

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    Middle Tree Liability Release Agreement:

     

    Middle Tree and I, the undersigned parent or legal guardian of the Minor, agree that the Activity (activities include any Middle Tree activities both on and off site) may pose risks, including possible illness, injury, as well as similar and dissimilar risks (hereinafter “Risks”). The undersigned is fully aware of the Risks and other hazards inherent in the Activity and is allowing the Minor’s voluntary participation in the Activity and assumes the Risks and all other risks of loss, damage, or injury that may be sustained while participating in the activity. We are also not liable for personal items and school materials assigned to the student. Middle Tree makes no representations or claims as to the condition or safety of the land, structures, transportation, or surroundings that may be involved in the Activity, whether or not owned, leased, operated or maintained by Middle Tree. It is understood that Middle Tree does NOT provide any insurance coverage for the Minor's person or property, and the Minor's parent(s) or guardian(s) acknowledge that they are responsible for the Minor's safety and the Minor's own health care needs, and for the protection of the Minor's property. In exchange for allowing the Minor to participate in these Middle Tree activities, the Minor, by and through the undersigned, the
    undersigned, and the Minor’s respective heirs, personal representatives and estates agrees to, in perpetuity, release from liability, indemnify and hold harmless Middle Tree and any agent, officer or employee of Middle Tree acting within the scope of their duties for any injury to the Minor's person or damage to the Minor's property. I authorize Middle Tree to take any appropriate action necessary in its judgment, including seeking medical care, if I am not present or reachable in the event of an emergency. The undersigned
    acknowledges that as a part of this Release he or she shall be 100% liable for the remuneration of any and all incurred medical expenses resulting from any injury incurred during, or as a result of, participation in the Activity. If any term of this agreement or the application to any person or circumstance shall, to any extent, be invalid or unenforceable, the remainder shall not be affected thereby, and each and every remaining term of this agreement shall be valid and enforced to the fullest extent permitted by law. In the event of any need to enforce this agreement, Middle Tree shall be entitled to its attorney fees and costs. This agreement will be governed by California law, County of Los Angeles. I, the undersigned, state that I am the parent or legal guardian of the Minor. I have fully read and understand the above terms and conditions and that they apply to said Minor and to myself, and that no oral representations, statements or inducements apart from the foregoing written agreement have been made to the undersigned. This document is binding on myself, the said Minor, and any person suing on behalf of said Minor.

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    As a member, I acknowledge that:

    ACADEMICS:
    ➢ Teachers are not responsible for keeping students entertained. When students are at Middle Tree they will be expected to pursue some
    kind of academic benefit.
    ➢ If your student does not bring his or her textbook and/or class notes he or she may not be able to receive the necessary help to
    complete assignments from school.
    ➢ Students and parents are responsible for keeping track of their own homework assignments, tests, and quizzes.
    ➢ If your student does not let Middle Tree teachers know about his or her project well in advance of the due date, then your student may
    not receive the necessary help.
    ➢ Middle Tree is not responsible for providing school, art or project supplies.
    ➢ Students with an IEP or a 504 Plan are encouraged to share it with Middle Tree staff before your student begins. Failure to do so will
    almost certainly prevent us from providing your student with the necessary help.
    ➢ The more communication Middle Tree staff has with parents the better we are able to assist our students.
    ➢ Test Preparation lessons are for standardized tests such as the SAT, ACT, SSAT, etc. Preparation for tests over the course of a student’s
    normal school year can be handled through the regular membership.
    LOGISTICS:
    ➢ A Middle Tree pledge contract cannot be paused; when pledging to support Middle Tree I am pledging to support a public mission
    that budgets around the pledges it receives.
    ➢ All registrations require a nonrefundable $100 registration fee, which covers matriculation and materials costs.
    ➢ Test Preparation (SAT, ACT, SSAT, GRE, etc) is billed separately from the general membership.
    ➢ The SEED (Student Enrichment through Educational Development) program is meant for students who need focused attention.
    Billing is assessed separately from the Unlimited membership.
    ➢ The SHADE program (Summer Hands-on Application Development in Education) is Middle Tree’s summer program and is billed
    separately from the general membership.
    ➢ Supplemental curriculum created outside of general hours will be billed separately from the general membership on an hourly basis.
    ➢ Unlimited program pledges will renew and be continuous until augmented or canceled regardless of the pledge term (dates noted on
    invoice).
    ➢ Overlays in the Unlimited Program might not be worked on during each visit depending on students’ workload and attendance.
    Overlays are a minimal focus and practice throughout the month in reflection on the monthly fee.
    ➢ Appointments and appointment changes (dates and times) must be made 48 hours in advance or they will not be honored. Limited
    courtesy financial credits may be given for scheduled programs (SEED, Test Prep, SHADE, Reboot, College Counseling, Dyslexia) but
    frequent appointment changes will result in the session being canceled or an additional fee per hour will be applied. Courtesy credits
    renew each semester.
    ➢ If a student cancels an appointment in less than 48 hours from the appointment time or fails to show up for their appointment, the
    appointment will be considered canceled, it will not be rescheduled and no financial credit will be applied.
    ➢ Students are expected to show up on time for appointments. Appointments will stop at the prescheduled time regardless of whether or
    not a student is on time.
    ➢ If a student is not picked up a half hour after Middle Tree closes and there is no communication with a parent or guardian, a late
    pick-up fee will be processed and child services will be contacted.
    ➢ Any student exhibiting signs of being sick or unwell should not come to Middle Tree and risk exposing other students and staff.
    Students who come into Middle Tree with signs such as coughing, sneezing, or a fever will be sent home and their session will be
    non-refundable.
    ➢ Program pledges are non-refundable regardless of student attendance. Cancellations after the 1st of the month will not result in a
    refund of that month's pledge.
    ➢ Cancellation of any program requires a filled out cancellation form and is subject to a cancellation fee. The cancellation fee amount is
    dependent on the program being canceled.
    ➢ All Unlimited memberships can be paused from June 1st to August 31st

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    PUBLICITY AUTHORIZATION FORM

    Middle Tree regularly produces and distributes instructional or promotional materials, both electronic and printed, to students, families, friends, prospective families, and the
    Educational Community. These materials may include, but are not limited to student-generated projects and podcasts to be shared with students or experts around the world, media placed on District websites, promotional brochures, etc. Once these materials are distributed they often make their way to the public domain and become generally available to the public for view and use.

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  • 31
    I understand that such media, which may or may not be accompanied by my child’s name, could appear on District websites, on District- approved websites, on other websites, or in print with or without my knowledge. I further understand that my child’s work, which may or may not be accompanied by his/her name, may be electronically displayed and produced. I further understand that once distributed by the District, my child’s photograph, video image, voice and/or work may find its way to the public domain.
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    PREFERRED PAYMENT TERMS AND CONDITIONS

     

    By completing this form, I authorize Middle Tree, its authorized representatives, and services provided to initiate electronic withdrawals from my designated account to make monthly payments on my contract for services. Should my preferred payment be declined, I authorize Middle Tree to process any other payment type on my account. I understand that I will receive confirmation specifying the date the electronic withdrawals will begin. I understand that I will continue
    to make my payment until I receive this confirmation and electronic withdrawals begin. A copy of this agreement shall serve as notice. I understand that this authorization and the program services in no way alter or lessen my obligation under my existing Middle Tree contract regarding the amounts of monthly payments, when payments are due, the
    application of payments, the assessment of late charges, or the determination of delinquencies. I certify that I am an authorized user of this credit card/bank account and will not dispute these scheduled transactions with my bank or credit
    card company so long as the transactions correspond to the terms indicated on this authorization form. I must maintain sufficient funds in my account for withdrawal of my payment amount. I understand that I must provide Middle Tree notice of at least 10 days for any request to modify, change, or terminate participation in this program. I agree to be bound by the Programs Terms and Conditions that are stated herein.

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          • Foundations
            $100.00 for each month
            SUBSCRIBE
          • Growth
            $160.00 for each month
            SUBSCRIBE
          • Summit
            $250.00 for each month
            SUBSCRIBE
            Credit Card
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            • United States
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            • Antigua and Barbuda
            • Argentina
            • Armenia
            • Aruba
            • Australia
            • Austria
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            • The Bahamas
            • Bahrain
            • Bangladesh
            • Barbados
            • Belarus
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            • Burundi
            • Cambodia
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            • Colombia
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            • Ecuador
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            • El Salvador
            • Equatorial Guinea
            • Eritrea
            • Estonia
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            • Faroe Islands
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            • French Polynesia
            • Gabon
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            • North Korea
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            • Kosovo
            • Kuwait
            • Kyrgyzstan
            • Laos
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            • Lebanon
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            • Libya
            • Liechtenstein
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            • Malawi
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            • Maldives
            • Mali
            • Malta
            • Marshall Islands
            • Martinique
            • Mauritania
            • Mauritius
            • Mayotte
            • Mexico
            • Micronesia
            • Moldova
            • Monaco
            • Mongolia
            • Montenegro
            • Montserrat
            • Morocco
            • Mozambique
            • Myanmar
            • Nagorno-Karabakh
            • Namibia
            • Nauru
            • Nepal
            • Netherlands
            • Netherlands Antilles
            • New Caledonia
            • New Zealand
            • Nicaragua
            • Niger
            • Nigeria
            • Niue
            • Norfolk Island
            • Turkish Republic of Northern Cyprus
            • Northern Mariana
            • Norway
            • Oman
            • Pakistan
            • Palau
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            • Panama
            • Papua New Guinea
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            • Peru
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            • Poland
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            • Republic of the Congo
            • Romania
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            • Rwanda
            • Saint Barthelemy
            • Saint Helena
            • Saint Kitts and Nevis
            • Saint Lucia
            • Saint Martin
            • Saint Pierre and Miquelon
            • Saint Vincent and the Grenadines
            • Samoa
            • San Marino
            • Sao Tome and Principe
            • Saudi Arabia
            • Senegal
            • Serbia
            • Seychelles
            • Sierra Leone
            • Singapore
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            • Slovenia
            • Solomon Islands
            • Somalia
            • Somaliland
            • South Africa
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            • South Sudan
            • Spain
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            • Sudan
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            • eSwatini
            • Sweden
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            • Syria
            • Taiwan
            • Tajikistan
            • Tanzania
            • Thailand
            • Timor-Leste
            • Togo
            • Tokelau
            • Tonga
            • Transnistria Pridnestrovie
            • Trinidad and Tobago
            • Tristan da Cunha
            • Tunisia
            • Turkey
            • Turkmenistan
            • Turks and Caicos Islands
            • Tuvalu
            • Uganda
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