Tutor Request Form (Summer 2021)We will start to make tutor referrals after school is over on June 9, 2021.Tutor Request Form (Summer 2021) This tutoring program is offered from June 10 - August 6, 2021. Thank you for your request. We will do our best to connect you with a tutor.Date* MM slash DD slash YYYY Your Name* First Last Are you applying for yourself or for your child?* Myself My childHow many students need tutoring?*Name of school / grade level of each student in Fall 2021*e.g. 1. Student 1: Green Elementary School - 3rd grade 2. Student 2: Walters Middle School - 6th gradeWhat is your preferred phone number?*Your Email Address* Enter Email Confirm Email What subject(s) does each student need tutoring? (Please pick no more than 3 subjects per student)*e.g. 1. Student 1: Math, History 2. Student 2: English, ScienceWhy do you need this tutoring?*Name of Parent / Guardian (if the applicant is a student)* First Last Email of Parent / Guardian*Liability Waiver and Release Form* Parental / Guardian Consent*I, the parent / guardian, hereby represent that I am, in fact, acting in such capacity, have consented to my child or ward's participation in the activities and/or events, and have agreed individually and on behalf of my child or ward, to WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons including Fremont Unified Student Store (FUSS) , and/or their directors, officers, employees, volunteers, representatives, agents, and sponsors. I further agree to save and hold harmless and indemnify each and all of the parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties because of any defect in or lack of such capacity to so act and release said parties on behalf of the child or ward and the parent or legal guardian.CommentsThis field is for validation purposes and should be left unchanged.
