Online Forms

Εmergency Form

If you prefer to fill out the forms on paper, check the box below. If not, you may continue.

In-person at a location

Name (Student's Full Name) *

AGE: *

BIRTH DATE (mm/dd/yyyy): *

GRADE: *

ADDRESS: *

STUDENT'S EMAIL *

PARENT'S NAME (GUARDIAN): *

First

Last

CELL PHONE: *

EMAIL ADDRESS *

WOULD YOU LIKE TO BE ADDED TO OUR REMIND TEXT THREAD/ MAILING LIST

Yes
No

*THIS THREAD WILL BE USED TO REMIND YOU ABOUT PERIODIC CLOSURES FOR HOLIDAYS, SCHEDULING UPDATES, OR REMINDERS ABOUT IMPORTANT UPCOMING PROGRAM EVENTS*

Referral/Other

Please mention the person who referred you or further describe 'other'. We greatly appreciate you taking the time to do this!

PLEASE DISCLOSE ANY SPECIAL NEEDS, OR LEARNING DISABILITIES THAT YOUR CHILD MAY HAVE:

We ask that you call Tutor Zone by 1p.m. on the day of your child's session if they are going to miss. Failing to call before 1p.m. will result in a $20 fee and failing to call or show to your scheduled appointment will result in a $45 fee. I agree *

Yes

Deposit Options *

Cash/Check
Credit card on file

Payment Agreement: Tutor Zone does not require our customers to pay in advance or sign a service contract; although with the high volume of students we ask that each customer place a credit card on file or a $100 cash/check deposit as an alternative. If at any time the account balance exceeds $70, the balance will be deducted from the agreed upon deposit. If the cash/check deposit is not used, it will be returned upon termination of services. However, if one of the packages was chosen, payment in advance is required and a deposit is not due for the amount of sessions paid.

Payment Period *

Weekly
Monthly

Form of Payment *

Credit Card
Email Invoice (monthly)

Packages (optional)

Bronze - $800
Silver - $1900
Gold - $3500

Name (parent/guardian) *

First

Last

By typing you name, both parties agree that this agreement may be completed electronically. The parties agree that a typed name appearing on this agreement is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.

Today's date (mm/dd/yyyy) *

How would you like to submit a credit card form?

Over the phone
In-person