Registration Globally Exclusive Registration FormAfter submitting your registration form, you will be contacted by phone or email to confirm your students schedule. Please enable JavaScript in your browser to complete this form.Email *Name of Parent or Guardian *Street Address, City, State, Zip *Primary Phone Number *Secondary Phone NumberEmergency Contact Name, Relation, and phone number *Student First and Last Name, MI *Student Date of Birth *MM/DD/YYYYAre there any medical conditions that we should be made aware of? If Yes, please describe below. List any known allergies, asthma, seizure history, or any other medical conditions we should be made aware of. School Attending *School DistrictAdelanto School DistrictAlta Loma School DistrictApple Valley Unified School DistrictBaker Valley Unified School DistrictBarstow Unified School DistrictBear Valley Unified School DistrictCentral School DistrictChaffey Joint Union High School DistrictChino Valley Unified School DistrictColton Joint Unified School DistrictCucamonga School DistrictEtiwanda School DistrictFontana Unified School DistrictHelendale School DistrictHesperia Unified School DistrictLucerne Valley Unified School DistrictMorongo Unified School DistrictMountain View School DistrictMt Baldy School DistrictNeedless Unified School DistrictOntario-Montclair School DistrictOro Grande School DistrictRedlands Unified School DistrictRialto Unified School DistrictRim of the World Unified School DistrictRiverside County office of EducationSilver Valley Unified School DistrictSnowline Joint Unified School DistrictTrona Joint Unified School DistrictUpland Unified School DistrictVictor Elementary School DistrictVictor Valley Union High School DistrictYucaioa-Calimesa Joint Unified School DistrictGradePre-KK1st2nd3rd4th5th6th7th8th9th10th11th12thHigher EducationWhich special services are being received at school? *N/AIEP504Gifted and TalentedOtherPlease indicate which model you prefer: 1:1 Online TutoringVirtual Small Group WorkshopChoose the preferred days and times you would like to schedule your tutoring appointment? Please choose at least 3 different days and/or times. *MondayTuesdayWednesdayThursday4:00 pm5:00 pm6:00 pm7:00 pmOtherHow does your student learn best?CANCELLATION POLICY I understand that if I must cancel an appointment, I must call at least 24 hours in advance. 24-hour notice is defined as one business day. Messages left over the weekend are not considered sufficient notice. Failure to cancel without a 24-hour notice will result in the loss of the tutoring session and/or $25 deposit for the scheduled tutoring session.I AcceptI Don't AcceptPRE PAYMENT POLICY I understand that I must use the promotional value within the timeframe provided and that the promotional value expires. I also understand that the instructor is solely responsible for the care and quality of the advertised educational services and no claims for refund shall be valid after the completion of the purchased sessions. Lastly, I understand that fees are non-transferable between programs, other students, etc.I AcceptI Don't AcceptPHOTO/VIDEO RELEASE I hereby grant permission to photograph my child and to record my child's voice, performances, poses, acts, plays, and appearances, and use their picture, photograph, silhouette and other reproductions of their physical likeness and sound as part of the tentatively entitled Globally Exclusive Promos and the unlimited distribution, advertising, promotion, exhibition , and exploitation of the Globally Exclusive Promos by any method or device now known or hereafter devised in which the same may be used, and/or incorporated and/or exhibited and/or exploited.I AcceptI Don't AcceptHow did you hear about us? *Google SearchYelpCare.comTeacher/School PersonnelFamily/ Friend ReferralFacebookInstagramOtherSubmit