Kids Under Construction - Student Enrollment Form

Student Enrollment Form

Welcome to Kids Under Construction! Please fill in your contact information and answer all of the following questions below so that we can get to know you and your student's needs better. Let's get started!

Guardian Information

Guardian's First Name

Guardian's Last Name

Guardian's Email

Guardian's Address

Guardian's City

Guardian's Zip Code

Guardian's Mobile Phone

How did you hear about Kids Under Construction?

How may we contact you?

May we use photos and/or videos of your student on our website or social media accounts?

FEES: You will pay Kids Under Construction $195 total for three enrollment sessions (3 total hours), plus an additional $30 if those sessions take place in your home. Thereafter, you will pay $55 for each 60 - minute tutoring session in our office, or $65 for each 60 - minute tutoring session in your home, that is scheduled for the month. Credit cards are kept on file, and we will run your card on the first of the month for services to be rendered that month.

RESCHEDULES WITH NOTICE: If you provide notice of the reschedule before 9:00am on the day of the scheduled tutoring session, you can reschedule the tutoring session for a different day or time. The new session must take place by the end of the following month of the rescheduled tutoring session. All rescheduled sessions must be scheduled while concurrently enrolled and may not be used to receive a credit/discount on the following month's billing or in place of a future session.

RESCHEDULES WITHOUT NOTICE: If you provide notice of the reschedule after 9:00am on the day of the scheduled tutoring session, you will not be refunded, credited or able to reschedule the session.

RESCHEDULE COMMUNICATION: If you need to reschedule your session (or provide late notice) for the week, please send written notification to Kristen Peters via text to 562-243-6488 or via email to [email protected]. You may also email your tutor.

TUTOR COMMUNICATION: If you need to communicate with your tutor, please email them. We do not allow our tutors to communicate with their students' families via their personal mobile phones, so please respect their privacy and limit communication to email and session your time only.

CREDIT CARDS: We will keep a credit card for you on file, and services are billed in advance on the first of the month for the entire month, and monthly bills may vary depending on the number of days that occur that month.

CONFIDENTIALITY: Any written, printed, graphic, electronically or magnetically recorded information furnished by Kids Under Construction for your use is the sole property of Kids Under Construction. This proprietary information includes, but is not limited to, curriculum, books, charts, graphs, marketing plans, reports, processes and any information concerning Kids Under Construction’s employees, clients, products, services, prices, or operations. You shall keep this confidential information in the strictest confidence, and will not disclose it by any means to any person except with Kids Under Construction's written approval. On termination of this agreement or at the request of Kids Under Construction, you shall return any confidential information in your possession to Kids Under Construction within five days.

NON-SOLICITATION: For a period of one year following the termination of this agreement, you agree not to do either of the following: (1) call on, solicit, or take away any of Kids Under Construction's tutors that you know of or become aware of as a result of contracting services under this agreement or (2) solicit or hire away any of Kids Under Construction's other tutors that you know of or become aware of as a result of performing services under this agreement. You agree that in the event of a breach of this provision, it would be impracticable or extremely difficult to fix the actual damage and, therefore, the breaching party will pay to the non-breaching party as liquidated damages, and not as a penalty, the minimum sum of $1,500.00 per student, which falls within the criteria above. This amount represents reasonable compensation for the loss incurred because of the breach and can be greater if Kids Under Construction can prove damages to be in a greater amount.

TERMINATION OF SERVICES: Kids Under Construction requires a 30-day written notification for termination of services.

By checking the box, I agree to the above terms.

Credit Card Details

By submitting your credit card, you consent the initiation of payments on your behalf for services that we provide to you. Summer Camp: Your payment will cover your selected camp(s) and their associated tuition. Private Tutoring: Your first payment of $195 covers three 60-minute diagnostic sessions in our office and a virtual 30-minute diagnostic blueprint consultation. You may add on an additional $30 to have your first three diagnostic sessions in your home instead of in our office. Thereafter, services are billed at $55 per 60-minute session online or in our office, or $65 per 60-minute session in your home. Sessions are billed in advance, on the first of the month, for the entire month, and monthly bills may vary depending on the number of days that occur that month.

Student Information

First Name

Last Name

What is your relationship to the student?

Birth Date

What is your student's gender?

What is your student's t-shirt size?

What health issues and/or allergies would you like us to be aware of?

What personal interests does your student have?

What else would you like us to know about your student?

Student's Academics

What is today's date?

Which school does your student attend?

In what grade is your student?

What are your student's academic strengths?

What are your student's academic weaknesses?

What are your academic goals for this student?

What else do you want us to know about your student's academics? Feel free to share specifics such as math facts proficiency, reading levels, and report card grades.

Tutoring Preferences

How many hour-long sessions would you like per week for this student?

On which days, and at what times, is this student available for tutoring? Please be specific (ex: Tuesdays from 4-6, Wednesdays from 1:30-7, etc)

Where would you like this student's tutoring sessions to take place?

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