RMLA Tutoring Application

Remote Learning Academy Tutoring Application

Please complete this application to begin the enrollment process for our faith-based tutoring program.
Parent / Guardian Information
Parent/Guardian Full Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Secondary Phone (optional)
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship to Student
Second Parent/Guardian Name (optional)
Second Parent/Guardian Email (optional)
Second Parent/Guardian Phone (optional)
Section 2 — Student Information
Student Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Age
Current Grade
School Type

HomeschoolPrivatePublicOther
Subject Needing Support (One subject per session)
Please note: Each tutoring session focuses on one core subject area. Bible and discipleship are included in every session. If you list more than one subject, we will assume you are requesting multiple weekly sessions (one per subject).
Learning Needs / Diagnoses (optional)
Current Curriculum/Programs Used (optional)
Scheduling Preferences

MondayTuesdayWednesdayThursdayFridaySaturday
Time Zone
Section 3 — Tutoring Format & Grouping
Which option are you applying for?

Solo (1:1)Group of 2Group of 3
If Group of 2 or 3: list the full names of the other student(s) who will join your group and their parent contact info.
Are you open to being matched with other families if your group is not yet full?

YesNo
Section 4 — Faith & Family Story (Optional but Encouraged)
Is your family Christian?

YesNoPrefer not to say
Share your family’s testimony:
Share about your child—strengths, struggles, and goals
Note to families: RMLA is a Christian tutoring program. We may pray, read short Scripture portions, and provide biblical encouragement as part of coaching and character development. (More in the Agreement below.)
Section 5 — How Did You Hear About Us?
Type a question

InstagramFacebookTikTokGoogle searchChurch/Ministry referral (name)Friend/Family referral (name)Returning familyOther
Name of person who referred you
Section 6 — Logistics & Payments
Preferred Start Date

MonthDayYear
Date
Estimated Weekly Session Load
Payment Method Preference

Debit /Credit CardACHStep Up ScholorshipOther
$50 Application Fee (non‑refundable)

I understand a non‑refundable $50 application fee is due upon submission and is required to process this application.
Section 7 — Policies & Agreement (Read Carefully)
A. Faith‑Based ProgramRMLA is a Christian tutoring service. We may pray with students, share brief faith‑based encouragement, and disciple students in Christ‑centered character (kindness, diligence, integrity, service) during sessions.

Yes, I understand & agree
B. No RefundsAll application fees, tuition payments, and prepaid packages are non‑refundable.

Yes, I understand & agree
C. 3‑Month Minimum CommitmentBy enrolling, you agree to a three‑month minimum. If you choose to withdraw before the end of three months, you are still responsible to pay the remaining balance for those three months. If you already paid for any portion, there will be no refunds.

Yes, I understand & agree
D. Autopay & InvoicesTuition is billed monthly in advance (or per your plan) and auto‑charged on file unless otherwise arranged in writing. Late payments may incur fees. Sessions are scheduled after the first payment clears.

Yes, I understand & agree
E. Cancellations & MakeupsParent cancellations with 24+ hours notice may be rescheduled subject to tutor availability within the same billing cycle. Same‑day cancellations/no‑shows are charged. If RMLA must cancel, we will reschedule or credit that session.

Yes, I understand & agree
F. Attendance & ConductStudents are expected to arrive on time, prepared, and respectful. Repeated disruptions may result in dismissal (financial terms above still apply during the 3‑month minimum

Yes, I understand & agree
G. Group Tutoring SpecificsGroup sessions move at a group‑appropriate pace. If a student needs more individualized pacing, we may recommend adding 1:1 sessions. Group rates assume full enrollment; if your group drops a member, your rate may adjust unless you provide a replacement within 7 days.

Yes, I understand & agree
H. Christian Content Consent I consent for my child to receive prayer, biblical encouragement, and discipleship as part of RMLA’s tutoring culture.

Yes, I consent for my child to receive prayer, biblical encouragement, and discipleship as part of RMLA’s tutoring culture
I. Media (Optional)I consent to RMLA using my child’s first name and photo/video from sessions in promotional materials

YesNo
J.CommunicationI agree to keep active communication with my tutor/lead teacher, check email/text for updates, and notify RMLA of changes to scheduling or payment info.

Yes
K. Technology & RecordingOnline sessions may not be recorded or redistributed by families without written permission. RMLA may record sessions for training/quality with notice.

Yes, I agree & understand
L. LegalRMLA is not a medical or psychological service and does not guarantee specific score/grade outcomes. By participating, you release and hold harmless RMLA and its contractors from claims arising from ordinary use of the service.

Yes, I understand and agree
Section 8 — Signatures & Consent
Full Name of Signee
Date

MonthDayYear
Date
I certify all information is true and complete.

Yes, I certify all information is true and complete.
I agree to the RMLA Tutoring Agreement and Policies above.

Yes, I agree to the RMLA Tutoring Agreement and Policies above.
Signature

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My Products

$50 Application Fee (non-refundable) Product Image

$50 Application Fee (non-refundable) This $50 application fee covers administrative processing, student intake review, and tutor placement coordination. It is non-refundable and required to secure your child’s place in the application queue. Once payment is received, you will receive an email confirmation and instructions to schedule your consultation call.Payment can be made securely through Square on the website or through the link provided after submission.

$50.00 Quantity
Item subtotal:$0.00

Total

$0.00

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

ACH Bank Transfer

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Remote Learning Academy Tutoring Application

Parent / Guardian Information

Section 2 — Student Information

Section 3 — Tutoring Format & Grouping

Section 4 — Faith & Family Story (Optional but Encouraged)

Section 5 — How Did You Hear About Us?

Section 6 — Logistics & Payments

Section 7 — Policies & Agreement (Read Carefully)

Section 8 — Signatures & Consent

Payment Methods