Sowing Seeds With Faith
Sowing Seeds with Faith Tutoring Registration Form
Name of Scholar:
Name of Scholar:
Date of Birth:
Name of Parent or Guardian:
Street Address City, State, Zip:
Parent or Guardian Email Address:
Parent or Guardian Cell Phone Number:
Scholar Cell Phone Number:
Name of Emergency Contact (Please Note Relation to Scholar):
Emergency Contact Phone Number:
School Phone Number:
Please indicate which area(s) where help is needed [Check all subjects that apply]:
Attention to detail/Focus
Which special services are being received at school?
Special Education Level
Any diagnoses that affects your child’s learning?
Tutoring | (Choose two weekdays; One time slot per day):
These spots are allocated to you until you contact us with a change. The changes MUST be submitted by the Sunday of the week of tutoring. We schedule our staff based on your time preference. It is extremely difficult to adjust the day of your session, so please pick a time that doesn’t place you in any time constraints or predicaments. Sessions are exactly one hour so, please arrive 10 minutes prior to session starting. Please Initial that you have read, understand, and accept terms of this program.
How does your scholar learn best?
Do you have any suggestions for your scholar’s tutor?
I understand that I will be part of the goal setting process for my student, and I will allow my student’s school to release relevant educational information regarding my student to the appropriate parties for educational research. I also understand that Mr. Fleming will be making frequent visits to my scholars’ educational institution to check on grades, behavior, and attendance.