YSLC Tutoring Registration Form

YSLC Tutoring Student Registration Form

Fill out the form carefully for registration
Student Name*

First NameMiddle NameLast Name
#2(Student Name)*

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Birth Date(Student 2)

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Name (If Student is a minor)*

First NameMiddle NameLast Name
Parent E-mail*
example@example.com
Phone Number*
Tutoring Availability: What day of the week works best for your tutoring sessions?*
Note: Registering more than one scholar? If your preferred time slot is fully booked, the second student will be scheduled to start 30 minutes after the first
Tutoring Time

Hour Minutes

AM/PM Option
Tutoring Subject
To help us provide the best possible learning experience, please share anything else we should know about your scholar. This could include their learning style, interests, strengths, areas where they need extra support, or any other relevant information that will help us understand them better.
Tutoring Fee Breakdown :
Payment
We add a $3.25 surcharge for each invoice payment. No-Shows or No Call : If a student does not show up for a scheduled session within 15 minutes of the start time without prior notice, they will be charged the full session fee of $40.00. If payment is not received the day of service or prior arrangements have not been made, you will be assessed a $10 late fee.
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Daily Tutoring
Hourly

$40.00 Quantity

Daily Tutoring
30 minutes

$20.00 Quantity

Total

$0.00
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YSLC Tutoring Student Registration Form