What is your name?
*
First Name
Last Name
What is your email?
*
(Please enter the primary email you use with Teamwork)
What is your learner's first name and initial of last name?
*
Will the family schedule change for the fall?
*
Yes
No
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Fall Availability
Please let us know what your availability will be like for this fall. If you are available multiple times in a day (e.g. Monday 9am-12pm and 4pm-6pm), then please add that as a note at the bottom of this page.
What days are you available for services?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Monday
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Tuesday
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Wednesday
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Thursday
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Friday
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Saturday
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Sunday
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
When will this new availability start?
-
Month
-
Day
Year
Date
When will this new availability end?
-
Month
-
Day
Year
Date
Are there any other limitations or times you are available that is not listed above? If so, explain.
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Confirm Your Details
Please confirm your email and name are correct. If not, please correct it on the first page before submitting.
Your Name
First Name
Last Name
Your Email
Submit
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