Avenue Family Center Tutoring Registration Form
Student's Full Name *
Name he or she wishes to be called, if different.
Parent/ Guardian Information
Mother's (Female Guardian) Name *
Address *
Primary Phone *
Secondary Phone
E-Mail Address *
If you do not have one, type not applicable in the box.
Father's (Male Guardian) Name *
Address
Only needed if it is different from the address above.
Primary Phone *
Secondary Phone
E-Mail Address *
If you do not have one, type not applicable in the box.
Student Information
Hobbies/Interests
Allergies
Any that a tutor might need to be aware of.
Medical Conditions
Any that a tutor might need to be aware of.
Birthday
Age *
School *
Grade in School *
What subject area or areas does your student need help in? *
Required
Are the any specific things they are really struggling with?
This could be the specific class (i.e. Algebra 1) or it could be a skill that you have noticed they have trouble with (i.e. multiplication facts).
Emergency Contact Infomation
Someone who does not live with the student.
Emergency Contact's Name *
Relationship to Student *
Phone Number *
Survey
Would you be interested in:
Check as many boxes as you would like more information about.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.