Dragonfly Education

Dragonfly Education Enrollment Form

 

Client Information:

Parent/StudentParent/Student
Name:Name:
Phone/Mobile:Phone/Mobile:
Email:Email:
Address:Address:
Does tutoring take place at this address?Does tutoring take place at this address?

Student 1

Student Name:School:Age:Grade:Area of Tutoring:
Phone/Mobile:Email:Birthday:Teacher(s):
Comments:

Available days to be tutored:

SundayMondayTuesdayWednesdayThursdayFridaySaturday
Student 2
Student Name:School:Age:Grade:Area of Tutoring:
Phone/Mobile:Email:Birthday:Teacher(s):
Comments:

Available days to be tutored:

SundayMondayTuesdayWednesdayThursdayFridaySaturday
Tutoring Package
Sessions/Week:Session Length:Block of Hours:Rate/Hour:Materials Fee:Registration Fee:
Total Investment:
Payment Method
Payment Method:Payment Option:Number of Payments:Payment/Monthly Payment Rate:

NOTE: Monthly payment plans are equal installment plans and do not reflect the hours used.  Registration and material fees will be added to the first payment and are non-refundable.

Name of Card Holder:Card Number:Expiration:CSV/CVV:

Please read and agree to the Terms and Conditions and Services Privacy Policy. The admittance of a Dragonfly Education placed tutor into your home will also confirm your agreement to our Terms and Conditions.

Leave this empty:

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Signature Certificate
Document name: Dragonfly Education Enrollment Form
lock iconUnique Document ID: 3b913fd73ab76d9de622aadf86836dd52ade2336
TimestampAudit
March 28, 2023 2:42 pm MDTDragonfly Education Enrollment Form Uploaded by John Rogers - John@Dragonfly.Education IP 174.29.178.154
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