Age:

Date of Birth:

Name of Parent or Guardian:

Street Address City, State:

Zip Code

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 Attending:

School Phone Number:

Teacher's Name:

School Counselors Name

Grade:

Academics

Scholars MAP Scores

Special Services

Special Education Level

Any diagnoses that affects your child’s learning?

Tutoring | (Choose two weekdays; One time slot per day):

How does your scholar learn best?

What method do you use to communicate with scholars teachers and counselors? (i.e. Facebook Portal, Google, Email, Class Dojo, etc.)

Do you have any suggestions for your scholar’s tutor?

Sowing Seeds with Faith Tutoring Registration Form