H.O.P.E Learning Tutor Intake Questionaire
Welcome to H.O.P.E Learning Tutorials, LLC! Please complete the form to provide information about your child to assist us in developing a tutoring plan.
Email address *
Child's Name: *
Grade: *
Parent/Guardian's Name:
Phone Number: *
Emergency Name and Phone Number: *
Requested Services: *
Required
Which days of the week work best for sessions? Please select all that apply!
Is there anything that you would like us to know about your child?
Media Release: *
By checking this box, I hereby consent to the participation in interviews, the use of quotes, and the taking of photographs, movies, or video tapes of the participant named above. I also grant the right to edit, use, and reuse said products for nonprofit purposes including use in print, on the internet, and all other forms of media by H.O.P.E Learning.
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