Enrollment Application - Tots 'N Tutors

Child's Name: *

DOB: *

Date of Birth of Child

Home Address: *

Mother's Name:

Father's Name:

Phone: *

Secondary Phone:

Email: *

Secondary Email:

Subjects of concern:

GPA:

Grade Level:

School Name:

School District:

Tutoring Availability - Monday

Morning
Afternoon
Evening

Tutoring Availability - Tuesday

Morning
Afternoon
Evening

Tutoring Availability - Wednesday

Morning
Afternoon
Evening

Tutoring Availability - Thursday

Morning
Afternoon
Evening

Tutoring Availability - Friday

Morning
Afternoon
Evening

Tutoring Availability - Saturday

Morning
Afternoon
Evening

Tutoring Availability - Sunday

Morning
Afternoon
Evening

Do 1-hour OR 2-hour sessions work?

1-hour
2-hour
BOTH WORK

What specific hours fit your schedule?

Tuition Rates

Tuition Rates $50/ for all mobile & online sessions (additional fee for travel beyond 25 mile radius from base) ** $45 / hour **Specials and promotional rates All fees must be paid on a daily or weekly basis. Weekly rates must be paid at the first session of the week.

I plan on paying with cash:

YES
NO

I plan on paying with a personal check:

YES
NO

I plan on paying with a credit/debit card (PayPal and Square fees apply):

YES
NO

I plan on paying using Cash app, Venmo, or Zelle (fees apply)/(please specify):

Cash App
Venmo
Zelle
None of the above

*Reminders for payment after 12 hours of a requested invoice payment will be subject to a 5% administrative fee added to the current invoice.

Cancellation Policy (please sign) *

A notice must be given 24 hours prior to a scheduled session to be a valid cancellation. The first three canceled appointments that do not meet this requirement will be subject to a minimum charge of $25. Subsequent cancellations will be subject to the full session rate charges. A notice to request cancellation of all services must be given at least 2 weeks prior to avoid session fees.

Date signed:

Comments or How did you hear about us?

I am willing to receive and respond to text and email messages as a suitable form of communication: *

YES
NO

I agree to allow Tots ‘N Tutors to use images for business promotions only on social media, website, and other marketing platforms: *

YES
NO