CLC Enrollment Forms

CLC Enrollment Forms
NA Student Name

First Name Last Name
Parent/Guardian Name

First Name Last Name
Parent/Guardian Email
example@example.com
Has your student attended CLC in the last 3 years and is your enrollment information up to date?

Yes, my student has attended CLC in the last 3 years and all enrollment information is up to date.*Yes, my student has attended CLC but my billing, academic, or release permission information has changed and requires updating.No, my student has not attended CLC in the past 3 years.
*Please note, returning students are still required to complete all required fields on this page.
Student Name*

Student's Legal First Name Student's Legal Last Name
Student Preferred Name
Student Preferred Pronouns
Pronouns
Student Mailing Address*

Street Address (Mailing)
Street Address Line 2 (Mailing)
City State / Province
Postal / Zip Code
Current School*
Name of School
Learning Format

Blended Online LearningRemote Learning (ie Edgenuity)
Name of Homeschool Curriculum
Grade*
Expected High School Graduation Year*
Student Phone

Area Code Phone Number
Student E-mail
example@example.com
Parent or Guardian Information:
Parent or Guardian Name*

First Name Last Name
Parent Mailing Address

Same as above
*

Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
Parent Email*
example@example.com
Preferred Contact*
Preferred Phone*

Area Code Phone Number
Alternate Phone
Area Code Phone Number

Academic Intake
Briefly describe your academic goals and what you expect to gain from your tutoring:
The student has:

An IEPA 504 Plan
Please explain and provide a copy at your first session:
Please explain and provide a copy at your first session:
Upload Forms Here (or drop at office)

Browse Files
Cancelof
Please provide any additional academic information you find relevant:
Please provide any additional academic information you find relevant:

Confidentiality and Records Release
Student's Legal Name*
Student's Date of Birth*

MonthDay Year
Date Format: mm/dd/yyyy
Current School*
Name of School
Name of School District
School Address

Street Address
Street Address Line 2
City State / Province
Postal / Zip Code
School Phone

Area Code Phone Number
I, {parentOr} grant permission to {nameOf} and any of its representatives (including, but not limited to: teachers, counselors, and administrators) to speak with teachers and/or tutors from Colorado Learning Connections regarding the academic history and progress of my child, {studentName}. I further authorize {nameOf} and any of its representatives to release any academic records, academic testing results, and/or schoolwork requested by Colorado Learning Connections.
Parent/Guardian's Signature:*

Clear
Date*

MonthDay Year

Photo Release
I, {studentName}, do hereby grant Colorado Learning Connections permission to use my likeness in a photograph or other digital reproduction in any and all of its publications, including website entries and social networking sites, without payment or any other consideration. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. I waive any right to royalties or other compensation arising or related to the use of photographs wherein my likeness appears. I hereby hold harmless and release and forever discharge Colorado Learning Connections from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
Student Name
Student Signature (over 18)

Clear
Consent for Minor

I am the parent or legal guardian of the minor named above and have the legal authority to execute the above release. I approve the foregoing and waive any rights in the premises.
Parent/Guardian Name
Parent/Guardian Signature

Clear
Date

MonthDay Year
Date

Policies
Please review our policies and general expectations and save the pdf for your reference.

CANCELLATION POLICIES:

24-hours notice is required for cancellation
If appointment is missed without 24-hours notice (MWON) the session is billed for the full-length of the scheduled appointment
- For exceptions, please read the full Policy Guide

BILLING POLICIES:

Billed monthly and emailed from Quickbooks, add this address to your inbox: quickbooks@notification.intuit.com
Pay an invoice: online via Quickbooks with credit card or bank transfer
Billing cycles are outlined in the table below:

Billing Category	Billing Period	Invoice Emailed Date	Due Date
Student Last Name: M-Z	11th - 10th of the month	By the 15th of the month	25th of the month
Student Last Name: A-L	21st - 20th of the month	By the 25th of the month	5th of the following month
Scholarship Student (all names)	Calendar month	By the 5th of the following month	15th of the month

COVID-19 POLICIES and GUIDELINES
- All students and tutors will wear masks over their mouth and nose for the duration of their sessions and while in shared spaces within CLC, unless otherwise explicitly discussed and agreed upon between both tutor and parent/guardian. Disposable masks are available upon request.
- Your student should not attend their in-person appointment if they have symptoms of COVID-19 or have been in contact with a positive case. If you need to cancel an appointment due to exposure risk, we ask that you either provide 24 hours notice of cancellation or notify CLC that you will attend your regularly scheduled appointment virtually.
- If a student is showing symptoms of COVID-19, their temperature may be taken and parent may be contacted. The student may be asked to leave CLC dependent on Colorado health guidelines.
- Your student will be asked to bring their own supplies whenever possible, and sanitize their hands and surrounding regularly.
By signing this agreement, I am indicating that I have read, understand, and agree to the policies listed in CLC’s Policy Document. Also, I acknowledge receipt and acceptance of the detailed billing policies as well as the appropriate contact information for Colorado Learning Connections. I understand that I will be billed for the full length of any appointment canceled or missed without proper notice.
Invoice Email*
example@example.com
Parent Name
Parent/Payer Signature*

Clear
Date*

MonthDay Year
Date

Receiving Updates and Information
How did you hear about us?
Want all the news on our newest programs and special offerings? Follow us on Facebook at Colorado Learning Connections - CLC, Instagram @coloradolearningconnections, and sign up for our email list.
Would you like to join our email list for news and special offers!?

Yes, sign me up!
Newsletter

Would you like to join our email list for news and special offers!?
Preferred email
example@example.com

We look forward to working with you!
A confirmation of your submission will be emailed shortly.
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Parent or Guardian Information: