new client sign up for summer 2010
Please fill out the following form to sign up for tutoring services. If you are an existing client trying to make a schedule change, please go to this page.
Parent's name 
Student's name 
School attending 
Grade level 
E-mail address 
Home address 
City 
State 
Zip code 
Home phone number 
Mobile phone number 
In what area(s) does your child require assistance? 
Will you be providing materials or activities, or does your child require lessons to be developed by Emergent Learning? 
Is there anything we need to know about your child that will help us serve him/ her better? (i.e. special needs, disabilities, impairments, etc.)
Please indicate your preferred location for tutoring sessions to be conducted 
Preferred start date 
Please list any dates that your child will be unavailable (i.e. vacation, camps, etc.) 
Are you interested in the summer book club? 
Frequency of services 
Duration of sessions 

Please select at least three time slots that fit your schedule best.
Monday
Tuesday
Wednesday
Thursday
Additional Comments:


(Please note that start times may be altered slightly. Once your information has been submitted, you will be contacted and your time slots will be confirmed.)