Momentum Tutoring Registration Form 2021-2022
Parent Agreement
The purpose of Momentum Tutoring is to provide affordable, convenient, and effective after school tutoring to children of all ages and abilities.
MOMENTUM WILL...
1. Offer programs that support and supplement California State Education Standards.
2. Encourage parent and classroom teacher input on child’s educational needs.
3. Design a custom curriculum plan based on child’s needs.
4. NOT provide a refund for a child’s illness or absence without 24 hours notice.
5. Dismiss a continually disruptive or noncompliant student
PARENT WILL...
1. Enroll in monthly contracts.
2. Pay tuition prior to tutoring. Tuition is due the 1st of each month.( if not prorated)
3. Pay a late fee of $15 if tuition is not paid by the 10th of each month.
4. Give two weeks notice if enrollment is to be changed or terminated.
5. Allow Momentum to review school progress reports and report cards.
6. Provide supervision prior and post tutoring. Be timely.
We agree to work together with the child’s best interest in mind. We understand because of the unique qualities involved with education. Momentum cannot guarantee any particular results.
Parent or Guardian Information
Guardian 1 (Primary Contact): First Name
Guardian 1: Last Name
Guardian 1: Email
Guardian 1: Mobile Phone
Guardian 2: First Name
Guardian 2: Last Name
Guardian 2: Mobile Phone
3 Goals for Tutoring
Emergency Contact: Relation to student
Emergency Contact: Phone Number
I Agree to the Terms
Select
Yes- I have read and agree to the terms above
No- I do not agree to the terms
COVID-19 Health and Safety Guidelines: I agree to the following guidelines for in-person tutoring
COVID 19 2
Cancellations are waived if due to any cold or flu like symptoms, or exposure to someone with active symptoms. Your student may be asked to wait a period of time before returning to in-person tutoring.
Session Information
Location
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Main Center 9500 Cuyamaca Street Suite #101
Online Tutoring
Academic Program
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30 minute Private Aide
40 minute Private Aide
60 minute Private Aide
K-3rd Study Hub 2:20-3:00 PM
All Grades Study Hub 3:00-4:00 PM
All Grades Study Hub 4:00-5:00 PM
9th-12th Study Hub 5:00-6:00 PM
Fun Friday 4:00-5:00 PM
Friday Morning Homeschool Program
K-3rd Rio Seco After School Program Mon-Fri
Certified Teacher for students with IEP and/or 504 Plans
Sessions Per Week
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1
2
3
4
Days Preferred
Times Preferred
Start Date Preferred
Tutor Preferred (If applicable)
Student Information
First Name
Last Name
Special Needs (IEP, 504 Plan, etc.)
Grade
School
Subject Focus and Class Schedule
Photo Release: I grant my permission to Momentum Tutoring to use photographs of my student for legal uses including but not limited to company social media, marketing, and website content.
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Yes- I grant my permission
No- Do not take or use photos of my child
How did you hear about us?
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