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First Name
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Middle Name
Last Name
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Phone
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Email
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Date of Birth
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Grade Level
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Teacher Name
Emergency Contact
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Emergency Contact Phone
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Student
Attendance
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No
I acknowledge that if I am unable to attend 2 tutoring sessions after signing up for them, I will not be allowed to sign up for any future tutoring at the Tandem.
COVID-19
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Yes
No
I pledge to wear a mask and practice safe social distancing during my tutoring session. I am aware of the risk of Covid-19 exposure related to in-person tutoring at the Tandem, and release the restaurant, its staff, volunteers, and other student participants from liability related to the risk of contracting Covid-19.
Email address used for Google Classroom
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