After-School Tutoring Program Consent Form
Student Information
Student Name
Grade
School
Parent/Guardian Information
Parent/Guardian Name
Phone Number
Email Address
Emergency Contact
Name
Phone Number
Medical Information
Allergies or Medical Conditions
Consent
I give permission for my child to participate in the After-School Tutoring Program. I acknowledge that I have read and understand the terms and policies of the program.
Parent/Guardian Signature
Date