Momentum Tutoring Registration Form 2022-2023
Parent/Guardian Agreement
The purpose of Momentum Tutoring is to provide affordable, convenient, and effective after school tutoring to students 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 student's educational needs.
3. Design a custom curriculum plan based on student's needs.
4. Provide a refund for cancellations made 24 hours in advance.
5. Dismiss a continually disruptive or noncompliant student.
6. Suspend services if invoices are past due.
Parent/Guardian will:
1. Establish a regular schedule for student's tutoring.
2. Support student progress by collaborating with Momentum and school as needed.
3. Provide progress reports and report cards as they become available.
4. Provide 24 hour notice to receive credit for a cancelled session.
5. Pay tuition prior to tutoring on the 1st of each month
6. Give two weeks courtesy notice if enrollment is to be changed or terminated.
7. Arrive on time for drop off and pick up.
We agree to work together with the student's best interest in mind. We understand because of the unique qualities involved with education, Momentum cannot guarantee any particular results.
Parent/Guardian Information
Parent/Guardian 1 (Primary Contact): First Name
Parent/Guardian 1: Last Name
Parent/Guardian 1: Email
Parent/Guardian 1: Mobile Phone
Parent/Guardian 2 (Secondary Contact): First Name
Parent/Guardian 2: Last Name
Parent/Guardian 2: Email
Parent/Guardian 2: Mobile Phone
3 Goals for Tutoring
Emergency Contact (Other than Parent/Guardian): Name and 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
Session Information
Location
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Main Center on Cuyamaca
Online Tutoring
Carlton Hills
Carlton Oaks
Academic Program
Select
30 minute Private Aide
40 minute Private Aide
60 minute Private Aide
30 minute Certified Teacher
40 minute Certified Teacher
60 minute Certified Teacher
60 Minute Homework Clinic for 6th-12th Graders
GTS Leadership Club
GTS Science Club
Mentor-to-Elevate
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 for Sessions
How did you hear about us?
Please provide the following items before or at the first session: 1.) Most recent progress report or report card 2.) IEP and/or 504 Plan: Current present levels and goals only
Select
I will email digital copies once I am contacted for scheduling
I will bring physical copies to the first session
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.
Select
Yes- I grant my permission
No- Do not take or use photos of my child
Momentum offers scholarships based on proof of income and household size. Are you interested in applying for a Momentum Scholarship?
Select
Yes
No
I already applied
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