Student's Name
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First Name
Last Name
Student's Birthday
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MM
DD
YYYY
Age
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Any Allergies?
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Current Grade Level
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School Experience
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None
Daycare
Public School
Private School
Homeschool
Other
Does your child have a 504 and/or IEP?
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What is your child's t-shirt size?
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Parent/Guardian Name
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First Name
Last Name
Email
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Phone
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(###)
###
####
Mailing Address in the States
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How do you prefer we communicate with you about scheduling, progress, and updates?
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Zoom/Google Meet
Phone Call
Text
Email
Other
What subject(s) does your child need tutoring in?
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Reading
Writing
Math
What prompted you to seek tutoring for your child at this time?
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Has your child received tutoring before? If so, what worked well or not well?
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If not, please type N/A
Are there specific goals you’d like us to focus on ?
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e.g., confidence, test prep, filling skill gaps, enrichment
How soon would you like to begin tutoring?
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How long do you anticipate your child will be enrolled in tutoring?
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We use this information to plan teacher contracts and ensure continuity for your child. If your plans change, please communicate with us as soon as possible.
Do you anticipate remaining enrolled during off-seasons or breaks in your child’s sports/travel schedule?
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Preferred Tutoring Frequency
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1x per week
2x per week
Does your child have reliable access to a computer and high-speed internet for virtual sessions?
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Please share any important details about sports training, travel, or other commitments that may affect your child’s availability.
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How would you describe your child’s learning style or personality?
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What challenges or learning gaps are you hoping to address?
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Is there anything we should know to help your child feel comfortable and confident?
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Would you be open to your child completing a standardized, adaptive assessment (MAP Growth®) to help us tailor their tutoring plan?
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Emergency Contact Name
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In the event of an emergency during a virtual session, this contact will be notified if parents/guardians cannot be reached.
First Name
Last Name
Relationship to Student
*
Phone Number
*
(###)
###
####
Email Address
*
Anything else we need to take into consideration?
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Share any details about your child’s learning needs, family schedule, timeline or other important information.
I hereby give permission for my child to participate in all lessons and learning activities affiliated with Courtside Homeschool Academy, LLC, and its teachers and staff. I acknowledge that Courtside Homeschool Academy (CHA) will not assume any responsibility or liability for personal injury or damages caused by accidents or illnesses during instruction, or while under the supervision of a CHA teacher or staff member. In the event that CHA is unable to reach a parent, guardian, or emergency contact, I hereby authorize Courtside Homeschool Academy to obtain and approve medical care for my child in the case of an emergency. As the child's parent or guardian, I assume sole responsibility for any expenses incurred as a result of necessary medical care.
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I hereby give Courtside Homeschool Academy, LLC absolute rights and permission to publish and/or print photographs, videos, and/or names of my child and/or myself taken during instruction or learning activities affiliated with Courtside Homeschool Academy (CHA), including CHA-sponsored events. These may be used for the following purposes: marketing materials, social media posts, website information, and all other publications of CHA. I understand that both my name and my child’s name may be used in connection with these photographs or videos. I agree that all such materials may be used without compensation to my child, me, or our family. I waive all rights to inspect or approve the use of photographs, videos, or names before publication. In the case that I wish for photographs, videos, or names of my child or myself to NOT be used in any way by Courtside Homeschool Academy, I agree to send written notice, signed and dated, stating that request.
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We understand plans change. We will gladly issue a full refund for any cancellation requests received within 14 days of the start of the program.
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