New Student Summer Registration        $30 registration fee for new students good through end of 2013

Parent Name  _________________________________________________________________________________________________________

Address           __________________________________________________________________________________________________________

Mom’s Cell ________________________  Dad’s Cell _______________________ Alternate ___________________________________

Parent Email ___________________________________________________________________________________________________________

Student Name _________________________________________________________________________________________________________

Student Address (if different from parent)  _________________________________________________________________________

Student Cell ________________________ Emergency Contact ____________________________________________________________

Names of those who may pick up child ____________________________________________________________________________

School Name __________________________________________________________ Teacher’s Name ______________________________

Grade Level _______    Tutoring / Class Requested ____________________________________________________________________

Specific areas of concern ______________________________________________________________________________________________

Test Results Available      FCAT         FAIR             DIBELS            ACT           SAT          OTHER

*If other list here _______________________________________________________________________________________________________

Start Date _____________________________ Projected End Date ________________________________________________________

Days Requesting Tutoring per week (circle all that apply)     M   T W R

Hours Requesting Tutoring each week (circle)         Morning   Afternoon         Evening

TUTORING AGREEMENT: The fee for tutoring is $__________ per hour based on individual/group tutoring.  Payment is due at the beginning of each month for that month’s upcoming sessions. We accept cash, check, or credit card. Make checks payable to THE LEARNING CURVE.  

Since our tutors specifically schedule with your child, please be mindful of their time, and if your child will not be able to attend a session due to a scheduling conflict, let us know at the beginning of the month so we may schedule an alternate appointment time for that week.  We understand that emergencies occur, and if we are given 24 hours’ notice of a cancellation, there will be no penalty; however, less than 12 hours before a session is scheduled will result in a $20 cancellation fee, and a no show will result in forfeiting that week’s payment. Likewise, if you are late to an appointment, the session will still end at the scheduled time due to the tutor’s other student appointments.

To notify us of a cancellation, please text: 850-556-8163. Please include your name and the student’s name in message. Please sign below acknowledging understanding and acceptance of the terms above.

Learning Curve Tutoring, LLC Representative Student Representative (parent or guardian)

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