Smart Abilities
 Tutoring Institute

 Enrollment Form
Choose Lesson Type:













Student's Name:  Home#:
Age(if under 18yrs.):  Work#:    Cell#:
Address:
City, State Zip:
Parent Name(s):

Special information you need to know about my child (optional):

School level/grade:   Elementary,   Junior High,      High School   Other

Family rates are available and should apply to one billing address only. Tuition is paid by the month (4 lessons/month), and is payable in advance at the beginning of each month. Payments received after the 10'th of each month shall be considered late and a $20.00 fee will be charged. Two weeks notice is required if canceling tutoring. The tuition reserves your place in the weekly lessons, and therefore, there is no reduction in tuition for missed lessons. It is necessary to call at least 6 hours before the class starts if a student will be absent. Make-up lessons will not be offered to any student forgetting a lesson or canceling at the last minute, except emergency or sickness. Please make an effort to be on time. It is a must that you bring the homework and books from school for math and reading. Folders, books, and materials must also be brought for other classes. Web price is an estimate.
Filled out by Smart Abilities
Yearly Registration Fee:
Monthly Tuition Fee:		 $__________
$    		 Type of payment:
Credit
Cash
Check   #______ 		Starting:
Date:
Day: ________
Time: ________
Total:$   Teacher:

____________________ ______ ____________________________
Student/Parent SignatureDateSA Representative

Smart Abilities
11124c Cypress North Houston
Houston, Texas 77065
Phone: (281) 970-2199 http://www.SmartAbilities.com