2020 Onsite Tutoring Application – Industry Kids United

Student Name *

First

Last

Date of Birth *

Parent / Guardian Telephone *

Work Number *

Email Address *

Please enter your email, so we can follow up with you.

Mailing Address *

What School Level is your child currently in? *

Does your child currently have any Allergies? *

Does Your Child Have Any Medical Condition we need to be aware of? *

If you answered yes please explain Medical conditions and Allergies we need t to be aware of. *

If your Answer is no Please Type in NA and move on to the next question.

Emergency Contact *

If parent is not available incase of emergency please provide the next best contact.

Do you have any comments or concern? *

Please Explain *