New Student's Registration Form

Please carefully review Our Policies before completing the form. If you have any questions, please feel free to contact our office. 

Student's Name *
Student's Name
Home Address *
Home Address
Parent's/Legal Guardian's Name *
Parent's/Legal Guardian's Name
Check all that apply *
Person(s) who will typically contact the office for appointment scheduling.
Student's Phone Number *
Student's Phone Number
Parent's Phone Number *
Parent's Phone Number
We periodically send newsletters concerning Extended Hours, Semester Final Review Session Information, and Holiday Office Closures. Would you like your email addresses added to the company email list? You may opt out of this email list at any time.
Please indicate if session information/feedback from the tutor is desired after the tutoring session.
Select one
Email address(es) for tutoring session feedback, if marked "Yes".
Please list tutoring subjects. Indicate course level for high school (Standard, Pre-AP/Honors, or AP), or indicate if subjects are college level.
Policy Agreement *
Thank you for completing this form! We'd like to make sure students and parents understand Payment and Cancellation Policies, which can be accessed on the company website at the link below. Please mark the box below to indicate this information has been read and understood.
How did you hear about us?
Let us know who referred you to the Tutoring Place and they can receive perks from our referral program.
Please provide any information you think may be helpful for the tutors to know about the student (he/she is attending tutorials, student has learning differences, etc.).
Entered into QB: Verified in QB: Added to M/C:
Would you like us to contact you by phone to schedule a tutoring session? Online booking is now available through the Schedule Appointment tab. *