Tutoring Registration Form

Tutoring Registration Form

2024-2025 Tutoring class is held every Wednesday from 4:30-6 PM beginning September 25th at the Latino Agency. This program is for homework help and not specialized tutoring. Please follow us on social media to get important updates- @LCDALatinoClub
Who are you looking to be?

StudentTutor
STUDENT INFORMATION
Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*
Student E-mail
example@example.com
Student Phone Number
School*
Grade*
Are you of Hispanic Heritage?*

YesNo
Race/Ethnicity*
Tutoring Subject
PARENT/GUARDIAN INFORMATION
Parent/Guardian*
Emergency Contact

We will always attempt to contact the parent/guardian first.
Emergency Contact*
Additional Comments
Authorization and Release

I, the parent/guardian, grant permission to the LCDA Latino Club for the use of my child's image in various media formats, including but not limited to online, news, and print.
- I understand this consent is valid until revoked in writing by the parent/guardian.
- I release the Latino Community Development Agency (LCDA) from all liability and obligations from any claim for injury, illnesses, claims, or demands.
- I understand that I have the right to revoke this consent at any time by providing written notice to lcdaclub@latinoagencyokc.org
- I understand that my child will not receive any monetary compensation.
- I/We hereby agree that we have read this agreement and are bound by it.
By clicking 'Submit,' you acknowledge that this action constitutes your electronic signature, affirming your consent and agreement to the terms and conditions provided as if you had signed a physical document.
Thank you for your interest in being a tutor!

Tutors are on a volunteer basis. We ask that you participate in as many meetings as you can. We will meet every Wednesday from 4:30-6 PM. This is a homework help program, meaning we help students with their homework from school or give worksheets on a related subject.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Personal Status*
School/Organization*
Please list where you go to school or where you work
Are you of Hispanic Heritage?*

YesNo
Race/Ethnicity
Please share any relevant experience*
Educational background, previously a tutor, etc.
Tutors 18+ years old are required to pass an OSBI background check. By pushing "Submit" you agree to obtain a background check and provide the LCDA with the receipt, if you wish to be reimbursed.
Parent Email*
example@example.com
Parent Phone Number*
Parent Work Number
Parent 2 Name

First NameLast Name
Parent 2 Email
example@example.com
Parent 2 Phone Number
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Relation to Student*
Student Name*

First NameMiddle NameLast Name
Should be Empty:

Tutoring Registration Form

STUDENT INFORMATION

PARENT/GUARDIAN INFORMATION

Emergency Contact