New Student Registration

Private Tutor Atlanta- Simplifying Learning

Student Name:

Parent/Caretaker (if student is under 18):

Student's Classroom Teacher (if applicable) :

Company/Organization Requesting Service (if applicable):

Student Address:

Student Email:

Student Phone Number:

Student's Date of Birth:

Student's Grade/Highest Level of Education:

Job/Career/Field of Study:

Target Goal(s):

Concerns Related To The Goal(s) :

ESL Students- Who Speaks the Most English To You?

PAYMENT/CANCELLATION POLICY: Please Check Each Statement Below To Mark You Have Read Our Policy

Sessions are Pre-Paid at Time of Reservation. We Accept Cash or Credit Card Payments

Weekly Reservations Require a Security Deposit Equivalent to the Cost of Your Weekly Session

We Have a No-Refund Policy for Weekly Reservations; Sessions May Be Rescheduled with the Week Pending Availability

Security Deposit Reserves Your Weekly Spot , Will Cover Missed Payment, and Can Be Applied to Your Last 2 Sessions (Pending No Missing Payments)

Tutoring Location:

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