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
Nickname
Student Preferred Pronouns
Pronouns
Student Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Current School *
Name of School
Learning Format

Blended Online Learning Remote 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 Contact
Alternate Phone

Area Code Phone Number

Add Additional Parent or Guardian Contact
Parent or Guardian Name

First Name Last Name
Parent Mailing Address

Same as previous parent
Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email
example@example.com
Preferred Contact
Phone Number

Area Code Phone Number
Alternative Contact
Phone Number

Area Code Phone Number

Collapse Stopper
Emergency Contact

(Other than parent)
Emergency Contact Name *

First Name Last Name
Relationship *
Preferred Contact *
Phone Number *

Area Code Phone Number
Alternative Contact
Phone Number

Area Code Phone Number

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

An IEP A 504 Plan
Please explain and provide a copy:
Upload Forms Here (or drop at office)

Browse Files

Cancel of
Please provide any additional academic information you find relevant:

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

Month Day 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 *

Month Day 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

Month Day Year
Date

Policies

Please review our policies and general expectations.
BILLING and CANCELLATION POLICIES
- Students must come to appointments on time and prepared. Students should bring their assignments, notebooks, textbooks, calculator, pencils, etc. If your student arrives late to his or her appointment, the appointment will end at its scheduled time and you will be billed for the full length of the original appointment.
- Students should plan to attend their scheduled sessions even if they have no homework or long-term projects. Tutors always have enrichment activities planned to help develop skills, reinforce areas of weakness, or pre-teach difficult concepts.
- You will be billed for the full length of any appointments missed without sufficient notice (see below).
- If you need to cancel or reschedule an appointment, please provide at least 24 hours notice. We understand that things come up, emergencies happen, and people get sick. When possible, your session will be moved to a virtual format at your regularly scheduled time. If you have an emergency we appreciate as much notice as possible. These may be waived on a case by case basis.
- If a student is late for an appointment or needs to leave early, you will still be billed for the full length of the appointment.
- If your regularly scheduled tutor is unavailable, CLC will schedule your appointment with another tutor at our discretion.
- Colorado Learning Connections has two billing cycles. Clients with last names beginning A-L will receive invoices via email after the 20th of each month and payment will be due on the 5th of the following month. Clients with last names beginning M-Z will receive invoices via email after the 10th of each month and payment will be due on the 25th of the same month.
- Any balances left unpaid 30 days after the invoice will be subject to a 10% latefee.
- Invoices will be emailed to {invoiceEmail} in accordance with the above billing schedule. To ensure that you receive all billing communications, please add admin@clcsummit.com, billing@clcsummit.com, and quickbooks@notifications.intuit.com to your address book.
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. 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.
- All students and tutors will sign in to the symptom checker upon arrival to CLC. If a student is showing symptoms of COVID-19, their temperature will be taken and parent will 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 area at the end of a session or as needed.
By signing this agreement, I am indicating that I have read, understand, and agree to follow the policies listed above. I am also acknowledging 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 cancelled or missed without proper notice.
Invoice Email *
example@example.com
Parent Name
Student Name *
Parent/Payer Signature *

Clear
Date *

Month Day Year
Date

Receiving Updates and Information
How did you hear about Colorado Learning Connections? (Ask about our referral program and get and learn how to get discounts!)
How did you hear about us?
Want all the news on our newest programs and special offerings? Follow us on Facebook at CLC Colorado Learning Connections, 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

Please save the following pdfs for your reference and select submit below.

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CLC Enrollment Forms

Parent or Guardian Information:

Emergency Contact

Academic Information

Demographic Information

Confidentiality and Records Release

Photo Release

Policies

Receiving Updates and Information

Please save the following pdfs for your reference and select submit below.