RVTC Tutoring Enrollment Form
We look forward to partnering with you in support of your child. Please complete this brief form to help us in finding the best fit for your family.
Parent or Guardian Information
First Name
Last Name
Email
Mobile Phone
Address
City
State
Zip
How did you hear about us? If it was a specific person, please include their name so we can thank them!
Today's Date
Student
First Name
Last Name
Date of Birth (type in this format 01/01/2001)
Gender
Select
Male
Female
Prefer not to answer
School
Grade
Subjects
History
Math
Other
Reading
Study Skills/Organization
Test Taking Skills
Writing
Session Preference: Subject to Availability
Select
1 on 1
Small Group (if available)
Either is fine!
Service Type
Online Sessions
In-Person Sessions
Open to Either or a Combination of Both
# of Weekly Sessions You'd Like
Select
5
4
3
2
1
Session Length?
Select
55 minutes (standard)
85 minutes
110 minutes
Which Programs?
Tutoring
Preschool
HW Club W 4-6 (subject to availability)
Homeschool Testing
Schedule Preference (List ALL Days & Time Ranges you are available).
Is your child on an IEP (Individualized Education Plan, Special Education, etc)?
Select
Yes
No
I'm not sure
ER Contact (if parent cannot be reached)
Any medical or health concerns we should be aware of?
Any food allergies or restrictions?
Can we offer a snack?
Select
yes
no
Do we have your permission to take and save a picture of your child for his/her profile? This will only be viewable by our staff.
Yes
No
Is there anything else you would like us to know?
Remove
Add Fields for Additional Student
Submit
