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Learning Bungalow
Blog
Client Scheduling
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Home
About
FAQs
Learning Bungalow
Blog
Client Scheduling
Academic Support for Elementary Students with a Specialty in Learning Disabilities including Dyslexia
Get Hired
Events
Onboarding Questions
Student's Name
*
First Name
Last Name
Address
*
Parent/Guardian #1 Name
*
Parent/Guardian #1 - Relation to Child
*
Parent/Guardian #1 Phone
*
Parent/Guardian #1 Email
*
Parent #2 Name
*
Parent/Guardian #2 - Relation to Child
*
Parent #2 Phone
*
Parent #2 Email
*
School Log In Information
Like Google Classroom, Blackboard, etc.
Emergency Contact
*
Relation to Student
*
Phone
*
Email
Does your child have allergies?
*
Yes
No
If yes, what are they?
Photo Release
*
When your children work on lessons, create special projects, or celebrate accomplishments, I often have many great photo and video opportunities. I would like your permission to use photographs and videos taken during session time (or off site related to student success) to share with families and for marketing purposes. Please indicate your preference.
I give permission for photos and videos of my child and their work to be used for marketing purposes.
I DO NOT give permission for photos and videos of my child and their work to be used for marketing purposes.
Would you like us to tag you? Please tell us your Facebook name and your Instagram handle.
Please tell us your Facebook name and your Instagram handle.
More Details
Anything else you'd like to share that you feel is pertinent.
Thank you!
