Custom Tutoring Sign Up Student

Student Full Name*

Student Grade*

School, State, and Country*

Parent Full Name*

Parent Email*

Choose Session*

What Should the Teacher Focus On?*

What Level is Your Child At in These Subjects?*

Is There Anything The Teachers Should Be Aware of About Your Child? (please do not disclose diagnoses unless comfortable)*

Any Preferred Times or Days?*

Questions, Comments, Concerns?

For children with disabilities ONLY

All fields with an asterisk (*) are mandatory.

The classes run once a week for four weeks. In total, you will receive four sessions.

Your registration will be guaranteed only after you receive an e-mail from us and filled out a customization form.

We are committed to protecting privacy rights. We respect your privacy and use it only to contact you.

This program has a very limited amount of space. Please apply ONLY if your child REALLY needs help.

Phone: (408)-982-7374

rainbowloopeduest@gmail.com

Monday – Sunday