*PLEASE PRINT AND FILL THIS OUT AND BRING TO FIRST TUTORING SESSION*

TUTORING REGISTRATION FORM

CHILD’S NAME_______________________________________

PARENT’S NAME(S)___________________________________

HOME ADDRESS_____________________________________

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HOME PHONE______________________________________

CELL PHONE_______________________________________

SCHOOL ATTENDING________________________________

GRADE___________________

TEACHER_________________________________________

SUBJECT STUDENT IS STRUGGLING WITH _________________

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