Student Lives With
Does Your Student Have Any Medical Condition(s) Or Allergies?
My student will be picked up from tutoring by someone on this form (Parent, Guardian and/or Emergency Contact).*
My student will return to the school provided After School Program.*
My student will take the bus home.*
My student will walk home from tutoring. I release all liability from JIM Enterprises.*
I give permission for my student’s photo to be taken for promotional materials.*
Please provide any additional information that would help us provide your student with the best support.
6, December 2023