Student Contract Form Step 1 of 2 50% Parent/Guardian Name* Address* Parent/Guardian's Phone*Parent/Guardian Email* Student's Name* Student's PhoneStudent Email School* Year of Graduation* What type of private tutoring are you looking for?* Test prep Subject-based tutoring Type of test prep* ACT PSAT SAT Test Date:* MM slash DD slash YYYY Educators available for test prep tutoring* Dr. Ene-Kaja Chippendale - English/Reading/Writing/Verbal ($125.00/hour) Ms. Samantha Edmonds - English/Reading/Writing ($95.00/hour) Ms. Nigelle Cochran - English/Reading/Writing ($95.00/hour) Ms. AnnElise Hatjakes Mrs. Melissa Lambert - English/reading/Writing ($95.00/hour) Dr. Gary Moss - - Math/Science - ($125.00/hour) Mr. Justin Burns - - Math/Science - ($95.00/hour) Mr. Tom Sharenborg - Math/Science - ($95.00/hour) Mr. Tim Larkin - - Math/Science - ($95.00/hour) Type of private subject-based tutoring* English tutoring Reading tutoring Math tutoring Science tutoring Study Skills Educators available for private subject-based tutoring* Ms. Samantha Edmonds ($80-$100.00/hour) Ms. Nigelle Cochran ($80-$100.00/hour) Ms. AnnElise Hatjakes ($80-$100.00/hour) Mrs. Melissa Lambert ($80-$100.00/hour) Mr. Justin Burns - H.S. and College Math ($80-$100.00/hour) Mr. Tim Larkin - Math/Science - ($80-$100.00/hour) Mr. Tom Sharenborg - H.S. and College Math/Science - ($80-$100.00/hour) Mrs. Shanna Barkume - Chemistry ($80-$100.00/hour) Mr. David Lankitus ($80-$100.00/hour) Prices are dependent on whether the student is in high school or college.ACT Prep Materials: $65 Packet of materials includes two student workbooks (English/Reading and Math/Science), supplemental worksheets, and 3 ACT practice tests. Materials can be picked up at Focus or mailed for an additional $20.Type of appointment set: Recurring As needed PAYMENT: Payment is due before or on the day of service. 1) Clients set their own appointments online and prepay using electronic payment services such as PayPal or VISA, MASTERCARD, DISCOVER, or AMERICAN EXPRESS.* If clients prefer to book appointments by phone or email, they will be billed using square payment systems. 2) Clients who prefer to pay by check on the day of service should call or text 573-239-4074 and leave a message. We will schedule your appointment through the office. Any collection fees/legal costs occurring from nonpayment will be the client’s responsibility. IF PAYMENTS AREN'T RECEIVED AFTER EACH APPOINTMENT, WE RESERVE THE RIGHT TO WITHHOLD FURTHER APPOINTMENTS UNTIL AN ARRANGEMENT FOR PAYMENT HAS BEEN MADE. *Cancellations made 24 hrs. prior to the appointment will be carried over to the next session. Late cancellations will be charged a full rate. CANCELLATIONS AND MISSED APPOINTMENTS: Cancellations must be made 24 hours in advance, except for illness or emergencies, or FULL rates will apply. Missed appointments (NO SHOWS) will also be charged FULL rates. Please leave a message or text for a call-back at 573-239-4074. STUDENTS MUST BRING ALL MATERIALS TO EACH SESSION. If students forget the materials previously provided for a follow-up session, they will be billed for new materials. Students will not be charged if they bring back the materials they have forgotten.I have read and understand these policies, and agree to abide by these terms and conditions* I agree Name* First Last Initials* Date* MM slash DD slash YYYY Δ
