LDB Educators Policy Acknowledgement Form
To ensure that the practices of parent consulting sessions are clear, a brief statement of policy is listed below. Please review and initial each policy and then sign below. A copy will be mailed to you for your records.

I, the client, hereby acknowledge that I have read and understand LDB Educators policies outlined on the provided page. I understand that my participation or engagement with LDB Educators will not commence until I have signed the below acknowledgment form.
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1. Cancellation Policy: The scheduling of a session involves the reservation of student and tutor time, therefore the client must give 48 hour cancellation notice prior to a scheduled session in order to avoid the cancellation fee (cancellation fee is the cost of the session).​​ 
Please sign parent's initials:
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2. ​Late Policy: Please be aware that if a client does not arrive within 15 minutes of the scheduled session start time, the session may be canceled and considered a no-show. In such cases, the session fee will still apply. To reschedule or discuss any issues, please contact me as soon as possible. Thank you for your understanding. 
Please sign parent's initials:
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3. Payment Policy: Sessions are to be paid directly after each session. There is a $25 fee for returned checks. 
Please sign parent's initials:
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4. Parent Discussion Policy: Parents are encouraged to call or request a call and discuss any concerns or student progress updates. A prorated session fee will be charged for calls in excess of fifteen minutes. 
Please sign parent's initials:
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5. Session Time Policy: The session fee is per 60-minute appointment. This fee will remain the same for one calendar year at which point the fee may increase by a specified amount a year. Please also be aware of prorated charges for overtime sessions when I stay past the scheduled time slot, extended conversations/calls/emails with parents, students, and teachers that exceed fifteen minutes, travel, collaboration with allied professionals, and editing time between sessions for papers and long-term projects. I encourage you to maintain open communication with me regarding your decision to authorize or pass on any of these options. 
Please sign parent's initials:
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6. Client Educational Understanding of Student Progress Policy: The Client acknowledges that my Educational services are a dynamic and evolving process tailored to the individual needs of each student. The Client understands that while every effort will be made to achieve positive outcomes, results can never be guaranteed due to the unique nature of each student's learning journey. 
Please sign parent's initials:
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7. Client Understanding of Duration of Learning Time Policy: The Client recognizes that the learning process in our sessions involves incremental progress, continuous informal assessment, and adjustments based on the student's ecosystem (academic level and skill set, social/emotional/mental health, other allied professional work, events in a student's life, etc...). The Client agrees to approach the educational learning process with patience and a long-term perspective, understanding that sustained improvement and progress requires consistent efforts over time. 
Please sign parent's initials:
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8. The parent acknowledges that I am a Special Education Educator as well as an IEP/504 Consultant. However, I am not a licensed attorney and cannot represent your child’s case in court. My role is limited to providing expert advice regarding your child’s IEP/504 Plan.
Please sign parent's initials:
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9. Acknowledgement of Risks and Limitations of Liability Policy: The Client agrees that LDB Educators shall not be held liable for any claims, demands, actions, liabilities, losses, damages, costs, or expenses, whether in contract or otherwise, arising from or related to the services provided. 
Please sign parent's initials:
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Parent Signature (Please type in first and last name):
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Please Enter Today's Date:
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Student Name (Please type in first and last name):
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A copy of your responses will be emailed to .
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