Course Registration Form - Valencia Tutors Learning Center

Summer Course Registration 2024

Date:
Format: mm/dd/yyyy

CONTACT DETAILS

Student Name (required)
Student Email (required)

Additional Student Name
Additional Student Email

Name of Parents (required)

Street Address (required)

City (required)State (required)Zipcode (required)

Home Phone (required)

Mother’s Cell (required)Mother’s Email
Father’s Cell (required)Father’s Email

Emergency Contact (required)
Emergency Phone (required)
Relationship (required)

Client grants permission to communicate via phone/text/email in regard to any activity related to Valencia Tutors Learning Center services.

Client understands that all tutoring and courses are done in a small group setting (no more than five students). These are not private sessions.

Client understands that their student may need both first and second semester in order to complete an entire school year's worth of credit.

I Agree To The Above Conditions

REGISTRATION DETAILS

Course 1(required)

Section

Times

Course 2 (optional)

Section

Times

*Section choice/time is dependent on availability and will be confirmed
through communication with the office.

Courses are not open ended and must be paid in full before a course completion notice is generated and made official. Students who do not complete a course are financially responsible for all course fees. Courses must be paid in full once a student is enrolled. Courses start when the first payment is made. The courses may not be dropped. There are no refunds.

Signature:

Date:
Format: mm/dd/yyyy

PAYMENTS

Payment Plans are available. Please contact the office.

Additional Fees - Lost books will need to be replaced at the cost of the student.
Make-up sessions incur an additional fee due to missed classes without communication with the office

I hereby authorize Valencia Tutors Learning Center to charge my credit card for payment and/or
default in payment.

Signature:

Date:
Format: mm/dd/yyyy

RELEASE OF COURSE COMPLETION NOTICES

Course Completion Notices must be signed for by the parent or student.

All services must be paid in full BEFORE Course Completion Notices are released.

Final payment may be paid in cash or by credit card ONLY.

By enrolling my student in Valencia Tutors’ courses, I am agreeing to the terms mentioned above for course completion, payment, and release of completion notices.

Signature:

Date:
Format: mm/dd/yyyy

Summer Course Registration 2024

CONTACT DETAILS

REGISTRATION DETAILS

PAYMENTS

RELEASE OF COURSE COMPLETION NOTICES

STUDENT SUPPORT

SUMMER HOURS

FALL / SPRING HOURS

VALENCIA TUTORS LEARNING CENTER