CLC Enrollment Forms

Academic Intake
Briefly describe your academic goals and what you expect to gain from your tutoring:
The student has:

An IEPA 504 PlanOther
Please explain and provide a copy at your first session:
Please explain and provide a copy at your first session:
Upload Forms Here (or drop at office)

Browse Files

Cancelof
Please provide any additional academic information you find relevant:
Please provide any additional academic information you find relevant:

Confidentiality and Records Release
Student's Legal Name*
Student's Date of Birth*

MonthDayYear
Date Format: mm/dd/yyyy
Current School*
Name of School
Name of School District
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Phone

Area CodePhone Number
I, {parentOr} grant permission to {nameOf} and any of its representatives (including, but not limited to: teachers, counselors, and administrators) to speak with teachers and/or tutors from Colorado Learning Connections regarding the academic history and progress of my child, {studentName}. I further authorize {nameOf} and any of its representatives to release any academic records, academic testing results, and/or schoolwork requested by Colorado Learning Connections.
Parent/Guardian's Signature:*

Clear
Date*

MonthDayYear

Photo Release
I, {studentName}, do hereby grant Colorado Learning Connections permission to use my likeness in a photograph or other digital reproduction in any and all of its publications, including website entries and social networking sites, without payment or any other consideration. In addition, I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my likeness appears. I waive any right to royalties or other compensation arising or related to the use of photographs wherein my likeness appears. I hereby hold harmless and release and forever discharge Colorado Learning Connections from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.
Student Name
Student Signature (over 18)

Clear
Consent for Minor

I am the parent or legal guardian of the minor named above and have the legal authority to execute the above release. I approve the foregoing and waive any rights in the premises.
Parent/Guardian Name
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date

Policies

Please review our policies and general expectations and save the pdf for your reference.
CANCELLATION POLICIES:
- 24-hours notice is required for cancellation
- If appointment is missed without 24-hours notice (MWON) the session is billed for the full-length of the scheduled appointment
  - For exceptions, please read the full Policy Guide
BILLING POLICIES:
- Billed monthly and emailed from Quickbooks, add this address to your inbox: quickbooks@notification.intuit.com
- Pay an invoice: online via Quickbooks with credit card or bank transfer
- Billing cycles are outlined in the table below:
Invoices are sent out on the 1st of each month and payment is due by the 15th
COVID-19 POLICIES and GUIDELINES
- All students and tutors will wear masks over their mouth and nose for the duration of their sessions and while in shared spaces within CLC, unless otherwise explicitly discussed and agreed upon between both tutor and parent/guardian. Disposable masks are available upon request.
- Your student should not attend their in-person appointment if they have symptoms of COVID-19 or have been in contact with a positive case. If you need to cancel an appointment due to exposure risk, we ask that you either provide 24 hours notice of cancellation or notify CLC that you will attend your regularly scheduled appointment virtually.
- If a student is showing symptoms of COVID-19, their temperature may be taken and parent may be contacted. The student may be asked to leave CLC dependent on Colorado health guidelines.
- Your student will be asked to bring their own supplies whenever possible, and sanitize their hands and surrounding regularly.
By signing this agreement, I am indicating that I have read, understand, and agree to the policies listed in CLC’s Policy Document. Also, I acknowledge receipt and acceptance of the detailed billing policies as well as the appropriate contact information for Colorado Learning Connections. I understand that I will be billed for the full length of any appointment canceled or missed without proper notice.
Invoice Email*
example@example.com
Parent Name
Parent/Payer Signature*

Clear
Date*

MonthDayYear
Date

We look forward to working with you!

A confirmation of your submission will be emailed shortly.
Should be Empty:

CLC Enrollment Forms

Parent or Guardian Information:

Academic Intake

Demographic Information

Confidentiality and Records Release

Photo Release

Policies

Receiving Updates and Information

We look forward to working with you!