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: *
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.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy