Registration Form

Share address of

Household Name ("The [student name] Family")

Parent 1 (You)

Parent 2

Contact 5

Contact 6

Contact 7

Contact 8

Share address of

Household Name ("The [student name] Family")

Parent 1 (You)

Parent 2

Student 1

Contact 6

Contact 7

Contact 8

Does child have special needs?

Yes

No

Is child allowed to be released from EdBoost to make purchases in our shopping center?

Yes

No

Is child allowed to be released to walk or take public transportation home or wait outside after hours?

Yes

No

Are your Emergency Release to People the same as Daily/Caropool Dismissal People?

Yes

No

I AGREE to provide EdBoost with written notification (either in the form of a note, letter, email, FAX, or a newly filled out registration form) of any changes in the above listed information.

Yes

No

I ALLOW my child’s (ward’s) photo or likeness to be used in any and all promotional or marketing materials produced by EdBoost or by any agency acting for EdBoost.

Yes

No

I AGREE to pay tuition for programs or courses in which my child (ward) is enrolled

Yes

No

I UNDERSTAND that EdBoost tuition must be paid for all services rendered and that refunds are not issued for missed tutoring appointments or Homework & School Project Assistance days.

Yes

No

I UNDERSTAND that EdBoost follows the LAUSD calendar and there are no EdBoost services on LAUSD days off (unless otherwise arranged). The LAUSD/EdBoost calendar is posted in the office and on the website.

Yes

No

I HAVE READ AND UNDERSTAND EdBoost’s policies and procedures and agree to abide by them. The EdBoost’s policies and procedures are is available at EdBoost or on the Internet at www.edboost.org/PoliciesProcedures.pdf.

Yes

No

I EXPRESSLY RELEASE and discharge EdBoost Education Corporation and their Staff, Volunteers, Directors, Administrators, and Members of the Board of Directors from any liability or responsibility for damage from injury related to any and all EdBoost activ

Yes

No

I GIVE MY CONSENT for my child (ward) to go home with the individuals listed above during a local emergency. In the case of a medical emergency and if I cannot be reached, I AUTHORIZE an EdBoost staff member to consent to any X-ray examination, anestheti

Yes

No

I GIVE MY CONSENT for EdBoost to request my child’s grades and test scores from LAUSD (if student is an LAUSD student) for EdBoost to use for evaluation purposes. EdBoost will not reveal any of your student’s personal information for any reason. EdBoost

Yes

No

I AGREE to provide EdBoost with copies of my student’s report cards and standardized test scores as long as my student attends EdBoost.

Yes

No

I UNDERSTAND that EdBoost may terminate this Agreement at any time for any reason. Failure by students or parents to adhere to the terms of this Agreement or EdBoost‘s policies and procedures may result in termination of this Agreement.

Yes

No

I UNDERSTAND that I will be charged $1 for every minute my child remains at EdBoost after 6:35.

Yes

No

One-on-one & Test Prep Tutoring Only

I UNDERSTAND that I must cancel tutoring appointments at least 24 hours in advance in order to avoid being charged for the session.

I UNDERSTAND that if I want to reschedule an appointment, I must reschedule at least 24 hours in advance in order to avoid being charged for the session.

I UNDERSTAND that if I must cancel an appointment for reasons other than my child’s illness, I should call to cancel the appointment. If I give less than 24-hours notice, I will be charged for the appointment but at my scholarship rate.

I UNDERSTAND that if my child fails to come for an appointment (for any reason), and I have not called to cancel the appointment, I will be charged the full price for the session (regardless of my scholarship rate).

I UNDERSTAND that I can give notice by email (edboost@edboost.org) or phone (310-559-1991) and if I leave a message with a tutor or on the machine I will be credited for having given notice.

I UNDERSTAND that I must provide 24 hours notice to withdraw my child from tutoring. If my child misses 2 consecutive sessions (without calling to notify EdBoost staff) EdBoost will take my child off of the schedule, but I will be charged for the two missed sessions.

I UNDERSTAND that if I cancel more than 5 appointments during a school year, for ANY reason, EdBoost may suspend my child from EdBoost services until further notice.

I UNDERSTAND that tutoring sessions start at the appointed time and run for 60 minutes (or specified amount of time). I understand that if my child is late, he/she loses part of his/her tutoring session. If my child is more than 10 minutes late, his/her tutor may cancel the session and I will be charged for that session.

I UNDERSTAND that there is a 15 minute grace period before and after tutoring (students may arrive 15 minutes early or stay 15 minutes after – except for tutoring appointments ending at 6:30). Students who arrive more than 15 minutes early or stay more than 15 minute late will be automatically enrolled in Homework Assistance for the day and families will be billed accordingly.

I UNDERSTAND that I must cancel tutoring appointments at least 24 hours in advance in order to avoid being charged for the session.

Yes

No

I UNDERSTAND that if I want to reschedule an appointment, I must reschedule at least 24 hours in advance in order to avoid being charged for the session.

Yes

No

I UNDERSTAND that I may cancel an appointment if my child is ill, but I agree to provide as much notice as possible, if I provide notice, I will not be charged.

Yes

No

I UNDERSTAND that if I must cancel an appointment for reasons other than my child’s illness, I should call to cancel the appointment. If I give less than 24-hours notice, I will be charged for the appointment but at my scholarship rate.

Yes

No

I UNDERSTAND that if my child fails to come for an appointment (for any reason), and I have not called to cancel the appointment, I will be charged the full price for the session (regardless of my scholarship rate).

Yes

No

I UNDERSTAND that I can give notice by email (edboost@edboost.org), text (424-209-7208), or phone (310-559-1991) and if I leave a message with a tutor or on the voicemail I will be credited for having given notice

Yes

No

I UNDERSTAND that I must provide 24 hours notice to withdraw my child from tutoring. If my child misses 2 consecutive sessions (without calling to notify EdBoost staff) EdBoost will take my child off of the schedule, but I will be charged for the two mis

Yes

No

I UNDERSTAND that if I cancel more than 5 appointments during a school year, for ANY reason, EdBoost may suspend my child from EdBoost services until further notice.

Yes

No

I UNDERSTAND that tutoring sessions start at the appointed time and run for 60 minutes (or specified amount of time). I understand that if my child is late, he/she loses part of his/her tutoring session. If my child is more than 10 minutes late, his/her

Yes

No

I UNDERSTAND that there is a 15 minute grace period before and after tutoring (students may arrive 15 minutes early or stay 15 minutes after – except for tutoring appointments ending at 6:30). Students who arrive more than 15 minutes early or stay more t

Yes

No

Homework & School Project Assistance (HASPA) Only

I UNDERSTAND that EdBoost is an educational facility. My child may stay at EdBoost until Homework & School Project Assistance ends at 6:30 as long as he/she is not distracting other students and is engaged in an educational activity. If my child does distract others and/or will not engage in educational activities, he/she will be asked to call a parent or guardian. My child will then wait in the waiting area until I, or one of my carpool/dismissal people, can pick him/her up. Students should be picked up w

MY CHILD HAS READ AND UNDERSTANDS the HASPA Student Contract and UNDERSTANDS that failure to comply with those rules may result in warnings, suspension, or expulsion. HASPA Student Contract available at www.edboost.org/HASPAStudentContract.pdf .

I UNDERSTAND that if my child is suspended/expelled from EdBoost for violation of the Student Contract, I will not receive a refund.

I UNDERSTAND that my child’s first week in Homework & School Project Assistance is a probationary week. If my child does not comply with the rules in the Student Handbook, my child will not be formally admitted into the program and I will receive a refund (minus one week).

I UNDERSTAND that we can sign up for homework help on a daily, weekly, monthly, or trimester basis. I will provide notice if my child will not continue to attend HASPA. I understand that all months are full, 4-week, months, except December and June which are prorated to 3-weeks.

I UNDERSTAND that EdBoost is an educational facility. My child may stay at EdBoost until Homework & School Project Assistance ends at 6:30 as long as he/she is not distracting other students and is engaged in an educational activity. If my child does di

Yes

No

MY CHILD HAS READ AND UNDERSTANDS the HASPA Student Contract and UNDERSTANDS that failure to comply with those rules may result in warnings, suspension, or expulsion. HASPA Student Contract available at www.edboost.org/HASPAStudentContract.pdf .

Yes

No

I UNDERSTAND that if my child is suspended/expelled from EdBoost for violation of the Student Contract, I will not receive a refund.

Yes

No

I UNDERSTAND that my child’s first week in Homework & School Project Assistance is a probationary week. If my child does not comply with the rules in the Student Handbook, my child will not be formally admitted into the program and I will receive a

Yes

No

I UNDERSTAND that we can sign up for homework help on a daily, weekly, monthly, or trimester basis. I will provide notice if my child will not continue to attend HASPA. I understand that all months are full, 4-week, months, except December and June whic

Yes

No

I HAVE READ AND UNDERSTOOD this entire form, and the information I have given is true and correct.

Yes

No

Does child have special needs?

Yes

No

Is child allowed to be released from EdBoost to make purchases in our shopping center?

Yes

No

Is child allowed to be released to walk or take public transportation home or wait outside after hours?

Yes

No

Are your Emergency Release to People the same as Daily/Caropool Dismissal People?

Yes

No

I AGREE to provide EdBoost with written notification (either in the form of a note, letter, email, FAX, or a newly filled out registration form) of any changes in the above listed information.

Yes

No

I ALLOW my child’s (ward’s) photo or likeness to be used in any and all promotional or marketing materials produced by EdBoost or by any agency acting for EdBoost.

Yes

No

I AGREE to pay tuition for programs or courses in which my child (ward) is enrolled

Yes

No

I UNDERSTAND that EdBoost tuition must be paid for all services rendered and that refunds are not issued for missed tutoring appointments or Homework & School Project Assistance days.

Yes

No

I UNDERSTAND that EdBoost follows the LAUSD calendar and there are no EdBoost services on LAUSD days off (unless otherwise arranged). The LAUSD/EdBoost calendar is posted in the office and on the website.

Yes

No

I HAVE READ AND UNDERSTAND EdBoost’s policies and procedures and agree to abide by them. The EdBoost’s policies and procedures are is available at EdBoost or on the Internet at www.edboost.org/PoliciesProcedures.pdf.

Yes

No

I EXPRESSLY RELEASE and discharge EdBoost Education Corporation and their Staff, Volunteers, Directors, Administrators, and Members of the Board of Directors from any liability or responsibility for damage from injury related to any and all EdBoost activ

Yes

No

I GIVE MY CONSENT for my child (ward) to go home with the individuals listed above during a local emergency. In the case of a medical emergency and if I cannot be reached, I AUTHORIZE an EdBoost staff member to consent to any X-ray examination, anestheti

Yes

No

I GIVE MY CONSENT for EdBoost to request my child’s grades and test scores from LAUSD (if student is an LAUSD student) for EdBoost to use for evaluation purposes. EdBoost will not reveal any of your student’s personal information for any reason. EdBoost

Yes

No

I AGREE to provide EdBoost with copies of my student’s report cards and standardized test scores as long as my student attends EdBoost.

Yes

No

I UNDERSTAND that EdBoost may terminate this Agreement at any time for any reason. Failure by students or parents to adhere to the terms of this Agreement or EdBoost‘s policies and procedures may result in termination of this Agreement.

Yes

No

I UNDERSTAND that I will be charged $1 for every minute my child remains at EdBoost after 6:35.

Yes

No

One-on-one & Test Prep Tutoring Only

I UNDERSTAND that I must cancel tutoring appointments at least 24 hours in advance in order to avoid being charged for the session.

I UNDERSTAND that if I want to reschedule an appointment, I must reschedule at least 24 hours in advance in order to avoid being charged for the session.

I UNDERSTAND that if I must cancel an appointment for reasons other than my child’s illness, I should call to cancel the appointment. If I give less than 24-hours notice, I will be charged for the appointment but at my scholarship rate.

I UNDERSTAND that if my child fails to come for an appointment (for any reason), and I have not called to cancel the appointment, I will be charged the full price for the session (regardless of my scholarship rate).

I UNDERSTAND that I can give notice by email (edboost@edboost.org) or phone (310-559-1991) and if I leave a message with a tutor or on the machine I will be credited for having given notice.

I UNDERSTAND that I must provide 24 hours notice to withdraw my child from tutoring. If my child misses 2 consecutive sessions (without calling to notify EdBoost staff) EdBoost will take my child off of the schedule, but I will be charged for the two missed sessions.

I UNDERSTAND that if I cancel more than 5 appointments during a school year, for ANY reason, EdBoost may suspend my child from EdBoost services until further notice.

I UNDERSTAND that tutoring sessions start at the appointed time and run for 60 minutes (or specified amount of time). I understand that if my child is late, he/she loses part of his/her tutoring session. If my child is more than 10 minutes late, his/her tutor may cancel the session and I will be charged for that session.

I UNDERSTAND that there is a 15 minute grace period before and after tutoring (students may arrive 15 minutes early or stay 15 minutes after – except for tutoring appointments ending at 6:30). Students who arrive more than 15 minutes early or stay more than 15 minute late will be automatically enrolled in Homework Assistance for the day and families will be billed accordingly.

I UNDERSTAND that I must cancel tutoring appointments at least 24 hours in advance in order to avoid being charged for the session.

Yes

No

I UNDERSTAND that if I want to reschedule an appointment, I must reschedule at least 24 hours in advance in order to avoid being charged for the session.

Yes

No

I UNDERSTAND that I may cancel an appointment if my child is ill, but I agree to provide as much notice as possible, if I provide notice, I will not be charged.

Yes

No

I UNDERSTAND that if I must cancel an appointment for reasons other than my child’s illness, I should call to cancel the appointment. If I give less than 24-hours notice, I will be charged for the appointment but at my scholarship rate.

Yes

No

I UNDERSTAND that if my child fails to come for an appointment (for any reason), and I have not called to cancel the appointment, I will be charged the full price for the session (regardless of my scholarship rate).

Yes

No

I UNDERSTAND that I can give notice by email (edboost@edboost.org), text (424-209-7208), or phone (310-559-1991) and if I leave a message with a tutor or on the voicemail I will be credited for having given notice

Yes

No

I UNDERSTAND that I must provide 24 hours notice to withdraw my child from tutoring. If my child misses 2 consecutive sessions (without calling to notify EdBoost staff) EdBoost will take my child off of the schedule, but I will be charged for the two mis

Yes

No

I UNDERSTAND that if I cancel more than 5 appointments during a school year, for ANY reason, EdBoost may suspend my child from EdBoost services until further notice.

Yes

No

I UNDERSTAND that tutoring sessions start at the appointed time and run for 60 minutes (or specified amount of time). I understand that if my child is late, he/she loses part of his/her tutoring session. If my child is more than 10 minutes late, his/her

Yes

No

I UNDERSTAND that there is a 15 minute grace period before and after tutoring (students may arrive 15 minutes early or stay 15 minutes after – except for tutoring appointments ending at 6:30). Students who arrive more than 15 minutes early or stay more t

Yes

No

Homework & School Project Assistance (HASPA) Only

I UNDERSTAND that EdBoost is an educational facility. My child may stay at EdBoost until Homework & School Project Assistance ends at 6:30 as long as he/she is not distracting other students and is engaged in an educational activity. If my child does distract others and/or will not engage in educational activities, he/she will be asked to call a parent or guardian. My child will then wait in the waiting area until I, or one of my carpool/dismissal people, can pick him/her up. Students should be picked up w

MY CHILD HAS READ AND UNDERSTANDS the HASPA Student Contract and UNDERSTANDS that failure to comply with those rules may result in warnings, suspension, or expulsion. HASPA Student Contract available at www.edboost.org/HASPAStudentContract.pdf .

I UNDERSTAND that if my child is suspended/expelled from EdBoost for violation of the Student Contract, I will not receive a refund.

I UNDERSTAND that my child’s first week in Homework & School Project Assistance is a probationary week. If my child does not comply with the rules in the Student Handbook, my child will not be formally admitted into the program and I will receive a refund (minus one week).

I UNDERSTAND that we can sign up for homework help on a daily, weekly, monthly, or trimester basis. I will provide notice if my child will not continue to attend HASPA. I understand that all months are full, 4-week, months, except December and June which are prorated to 3-weeks.

I UNDERSTAND that EdBoost is an educational facility. My child may stay at EdBoost until Homework & School Project Assistance ends at 6:30 as long as he/she is not distracting other students and is engaged in an educational activity. If my child does di

Yes

No

MY CHILD HAS READ AND UNDERSTANDS the HASPA Student Contract and UNDERSTANDS that failure to comply with those rules may result in warnings, suspension, or expulsion. HASPA Student Contract available at www.edboost.org/HASPAStudentContract.pdf .

Yes

No

I UNDERSTAND that if my child is suspended/expelled from EdBoost for violation of the Student Contract, I will not receive a refund.

Yes

No

I UNDERSTAND that my child’s first week in Homework & School Project Assistance is a probationary week. If my child does not comply with the rules in the Student Handbook, my child will not be formally admitted into the program and I will receive a

Yes

No

I UNDERSTAND that we can sign up for homework help on a daily, weekly, monthly, or trimester basis. I will provide notice if my child will not continue to attend HASPA. I understand that all months are full, 4-week, months, except December and June whic

Yes

No

I HAVE READ AND UNDERSTOOD this entire form, and the information I have given is true and correct.

Yes

No