Parent & Student Information

Parent/Guardian Name: *

Phone *

Email *

How would you prefer to be contacted? (Select one)

Students Age: *

Grade:

Which are your top 3 goals for tutoring? *

Tutoring Preferrences

Would you like regular progress updates?

Weekly

Bi-Weekly

Monthly

Preferred Schedule (Days/Times): *

Students Name *

Session Length Preference

30 minutes

60 minutes

How often would you like tutoring sessions? *

1x per week

2x per week

3x per week

Occasional homework help

Learning Insights

What motivates your child? *

Preferred Tutoring Format *

Virtual

In-Person

Either

Do you have any specific challenges or goals you’d like to share?

Payment & Packages

Which package are you signing up for?

Would you like to enroll in automatic billing? *

Yes

No

Parent Consent & Aknowledgement

I understand that:

Consistent attendance is essential for student progress.
Sessions canceled with less than 24 hours notice may not be rescheduled
All sessions must be prepaid to confirm scheduling.

Signature and Date:

Clear

How did you hear about Love for Learning? *

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