REGISTRATION FORM

Child's Name 1

Child's Name 2

Mother's Name

Mother's Address

Father's Name

Father's Address

Authorized Pickup A

Relation to Student

Authorized Pickup B

Relation to Student

Registration Fee $100.00 — due with registration Testing Fee: $100.00— due with registration Consultation Fee $75.00

Weekly Tuition: $200.00 per child weekly One-on-One tutoring: $60.00 per hour

PARENT AND/OR GUARDIAN MUST SIGN THIS SECTION BEFORE REGISTRATION IS ACCEPTED. 1 agree to the following policies regarding fees: Deposits are non-refundable; No refunds will be given for canceling. No refunds are given if a student is dismissed from the afterschool tutorial center due to disciplinary

Action; No refunds are given if students leave early due to other personal commitments. No Proration! There will be a $25.00 fee charged by Meagan's academic Tutoring Center for any check that is returned by the bank.

Meagan's Afterschool tutorial a Center has my permission to use photographs taken of my child while at the center for promotional purposes. We or I (Parents/Guardians) have read and agreed to all the conditions of this registration.

 Sign

 Date

I authorize the use of my children(s) photography in camp publication and/or website