Homework Tutoring Registration Form

Please fill out this form for each child that wishes to have homework tutoring at PACC.

IMPORTANT: Please make sure to download WhatsApp to keep up with all program communications. 

Our homework tutoring program is open to all kids in our community between the grades of KG to 8th. Homework help runs from September 11 to the end of the school year. The last day of tutoring for this school year will be on May 31.

Sessions will take place Monday through Friday from 4 pm to 6 pm (except on the days where PACC is closed, which are listed below). 

**You must confirm your child's attendance each day on WhatsApp so that we have an accurate head count of how many kids will be attending.**

PACC Homework Help is free only for those who have registered for our PACC Family Discount, which is $50 for the whole family for a year. For more information on our PFD, please visit our website, paccusa.org/programs.

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PACC will be closed for:

- THANKSGIVING from Thursday, November 24 to Sunday, November 26
- WINTER BREAK from Thursday, December 23 to Monday, January 2, 2023
- MEMORIAL DAY on Monday, May 29


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Participant Full Name / اسم المشترك *
Participant Birthdate / تاريخ ميلاد المشترك *
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DD
/
YYYY
Participant Age / عُمر المشترك *
Grade Level of Participant *
Participant School  *
Contact Person Name / اسم ولي الأمر *
Contact Person Email / البريد الإلكتروني لولي الأمر *
Contact Person Phone Number / رقم ولي الأمر *
Full Home Address / العنوان كاملاً *
Additional Emergency Contact Name / اسم للتواصل في حال الطوارئ *
Emergency Contact Phone Number / رقم للتواصل في حال الطوارئ *
Relation to Emergency Contact / صلة القرابة *
I read and consent to the COVID Liability Form by signing below and I acknowledge that we have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old or a parent/guardian and fully competent to give my consent and consent on behalf of my child(ren)(a minor 17 or under); That we (my child(ren) and I) have been sufficiently informed of the risks involved and give our voluntary consent in signing it as our own free act and deed; that we (my child(ren) and I) give our voluntary consent in signing this Liability Release Waiver as our own free act and deed with full intention to be bound by the same, and free from any inducement or representation. This waiver will remain effective until laws and mandates relevant to COVID-19 are lifted. لقد قرأت ووافقت على نموذج المسؤولية لكوفيد-19 ومن خلال توقيعي على النموذج أدناه، أقرّ أنّني قد قرأت نموذج إخلاء سبيل المسؤولية المذكور أعلاه، وأننّي أفهم محتوياته; أنني على الأقل 18 عاماً أو أنني ولي الأمر و أن لدي الصلاحية لكي أعطي موافقتي بالنيابة عن طفلي/أطفالي (قاصرين بعمر 17 أو أقل); وأن نحن (أطفالي وأنا) قد بُلِّغنا بشكل كافي عن الأخطار المتضمنة وأننا نعطي موافقتنا طَوعاً عن طريق التوقيع أدناه لضمان حرية الفعل; أن نحن (أطفالي وأنا) نعطيكم موافقتنا طوعاً عن طريق توقيع نموذج إخلاء المسؤولية مع النية الكاملة للارتباط بالمثل، بعيداً عن أي شكل من أشكال التوثيق أو التمثيل. مع العلم أن هذا الإخلاء سيبقى فعالاً حتى تُلغى جميع التقييدات المتعلقة بكوفيد-19 *
I understand that I am providing my electronic signature on this page, which is essentially the same as signing a paper document with a pen. By providing my electronic signature, I certify that I am providing accurate information and understand it will be used for the purpose outlined by the organization requesting the information. أنا أفهم أن توقيعي الالكتروني على هذه الصفحة، هو بمثابة توقيعي على ورقة حقيقية. وأؤكد أيضاً أنني أقدم معلومات صحيحة وأفهم أنها سوف تُستخدم للغرض الموضح من قبل الجمعية *
I agree that I am responsible for all payments due on the day of the first class I attend or in advance with the credit card information I provided. I also understand that the only way to secure my child's spot in this program is through payment.  *
I agree that if I do not make a payment upon completing registration my spot is forfeited. أوافق أنه إذا لم أدفع جزء من القسط عند التسجيل فإنني سوف أخسر مقعدي *
I understand that PACC's refund policy prohibits anyone from receiving a refund unless they provide a good, strong reason for their child no longer being able to attend the program(s) they registered for. If a reason is not provided, then PACC cannot issue a refund and will instead issue credit that can be used towards future programs at  PACC. *
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