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Academic Tutoring Request Form
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Indicates required field
Student Name
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First
Last
Birthday
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(MM/DD/YYYY)
Grade in School
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Responsible Party
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Email
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Cell Phone
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Texting ok?
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Yes
No
Work Phone
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Subject Material Requested
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Does the student have the necessary materials??
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Yes
No
Academic Experience
*
Comment
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I understand and agree that my picture/my student's picture may be used in Prodigy Studios marketing platforms.
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Yes
No
How did you hear about Prodigy Studios?
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Facebook
Twitter
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Prodigy Teacher
Friend/Family
Newspaper
Radio
Website
Other
Please read carefully. By submitting this form you're agreeing to our lesson policy:
Contract tuition is payable monthly in advance via autopay and is past due 10 days later. Students whose tuition accounts are past due are charged at the single lesson rate. Notification of inability to attend a lesson is a courtesy to the teacher but does not excuse tuition payment. Individual lesson appointments may not be rescheduled, however the teacher can make a telephone assignment on request. Registration and tuition fees are not refundable.
I agree to receiving marketing and promotional materials
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