100% Success Tutoring Application

100% Success Tutoring Program Application

Welcome to 100% Success Tutoring! We are excited to be part of your child’s academic journey. This application form is designed to gather important information about your child’s educational needs, learning preferences, and safety requirements, ensuring that we can provide the most personalized and effective tutoring experience possible.

By filling out this form, you’ll help us understand:

  • Your child’s academic strengths and areas for improvement.
  • Any special learning needs or accommodations.
  • Important contact and safety details, including authorized pick-up persons.
  • Your tutoring preferences, so we can tailor the sessions to fit your child’s needs.

Please provide as much detail as possible to help us offer the best support for your child. If you have any questions, feel free to reach out!

Email *
  (Child's Information)  - Full Name *
Date of Birth: *
MM
/
DD
/
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Grade Level: *
School Name: *
Primary Subjects of Concern (check all that apply):   *
Required
  (Parent/Guardian Information): Full Name   *
Parent Phone Number? *
Relationship to Child: *
Primary Contact Number: *
Email Address:   *
Home Address: *
Reason for Seeking Tutoring (check all that apply): *
  Educational Background and Goals  
Required
Areas of Strength (list subjects/skills where your child excels): *
Areas of Concern (list specific challenges or subjects): *
Academic Goals (What do you hope your child will achieve through tutoring?):   *
Preferred Session Frequency (check one): *
Learning Preferences (Does your child have any preferred learning styles? E.g., visual, hands-on, auditory):   *
  Learning Style and Special Considerations  
Special Learning Needs (Does your child have an IEP, 504 Plan, or specific learning accommodations?): *
Any Behavioral Concerns (Please describe if any): *
Does your child have any known allergies, medical conditions, or health needs that we should be aware of? If yes, please explain.   *
Approved Pickup Persons (List names of individuals authorized to pick up your child from tutoring):   *
 Child Safety and Pickup Information  
Any Additional Notes or Special Requests:   *
  Consent and Agreement :

I, the undersigned, hereby give consent for my child to participate in tutoring sessions with 100% Success Tutoring. I understand that this program is focused on enhancing my child's academic abilities and that the tutors will work diligently to create a safe and productive learning environment.

I agree to promptly communicate any changes in contact information, emergency contacts, and health or safety needs of my child.

Please type below Full Name for Agreement of Conditions
 *
Do you consent and agree to all information above and the polices in place? *
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