ACE: Academic Christian Education Tutoring Registration

2. Tutoring is available for students of all ages on Tuesdays and Thursdays 6:30-7:30 pm. Please bring homework, tests, quizzes, etc to the session.

4. Student Information

6. Student's Name*

   First Name

7. d*

   Last Name

9. Parent/Guardian's Name*

   First Name

10. d*

    Last Name

12. Home Address (Street)*

14. City*

15. State*

16. Zip*

18. Home Telephone *

    Please include area code

19. Work

    Please include area code

20. Cell

    Please include area code

22. E-mail*

26. Emergency Contact Information
    must be different than adult listed above

    must be different than adult listed above

28. Full Name

29. Relationship to child

31. Phone Number

33. Food Allergies/Special Needs

37. Academic & Tutoring Information

39. Age*

40. Grade (For Kindergarten place the value '0', for all other grade place a 1-12)*

42. Indicate the subject(s) you need help with*

44. Name of Tutor (if returning student)

46. Is your child in a special program at school?
    -- Select One --YesNo

47. If yes, name the program (TAG, L.D., etc.)

49. School Name*

50. School Location*

    City and State

52. Please provide all information requested (according to your first choice subject)

54. Full Name of Classroom Teacher.

    (Please leave blank if you do not feel comfortable having a tutor contact the teacher)

55. Teacher's E-mail Address (if known)

57. I agree that my child will attend each weekly evening instructional session (Tuesday or Thursday) and will call the instructor IN ADVANCE if this is not possible. In addition, I will submit a copy of my child(ren’s) report card to the instructor on the next instructional session following receipt of it.*

    1. I agree
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

* indicates a required field