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Avenue Family Center Tutoring Registration Form
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* Indicates required question
Student's Full Name
*
Your answer
Name he or she wishes to be called, if different.
Your answer
Parent/ Guardian Information
Mother's (Female Guardian) Name
*
Your answer
Address
*
Your answer
Primary Phone
*
Your answer
Secondary Phone
Your answer
E-Mail Address
*
If you do not have one, type not applicable in the box.
Your answer
Father's (Male Guardian) Name
*
Your answer
Address
Only needed if it is different from the address above.
Your answer
Primary Phone
*
Your answer
Secondary Phone
Your answer
E-Mail Address
*
If you do not have one, type not applicable in the box.
Your answer
Student Information
Hobbies/Interests
Your answer
Allergies
Any that a tutor might need to be aware of.
Your answer
Medical Conditions
Any that a tutor might need to be aware of.
Your answer
Birthday
Your answer
Age
*
Your answer
School
*
Your answer
Grade in School
*
Your answer
What subject area or areas does your student need help in?
*
Math
Science
Social Studies
English
Foreign Languages
Other
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).
Your answer
Emergency Contact Infomation
Someone who does not live with the student.
Emergency Contact's Name
*
Your answer
Relationship to Student
*
Your answer
Phone Number
*
Your answer
Survey
Would you be interested in:
Check as many boxes as you would like more information about.
More information about what Avenue Family Center offers.
Attending a money management workshop.
Attending a Bible study.
Finding a church to attend.
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