A Smarter You Tutoring Center

FORMS

A Smarter You Tutoring Center

Student Name:

Grade:

School:

Parent 1:

Address:

Email:

Primary Phone:

Alternate Phone:

Text?:

Yes

No

Parent 2:

Address (if different):

Email:

Primary Phone:

Alternate Phone:

Text?:

Yes

No

Sibling 1 Name:

Sibling 1 Age:

Sibling 2 Name:

Sibling 2 Age:

Sibling 3 Name:

Sibling 3 Age:

Sibling 4 Name:

Sibling 4 Age:

Educational Concerns:

Other Things We Should Know To Best Help Your Child?

How Did You Learn About Us?

Signs

Website

Facebook

Referral

Food Allergies (if yes, please list):

Thank you for submitting the Information Sheet.

We look forward to working with your child!

Debbie Meisegeier

A Smarter You Tutoring Center

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