Tutor Request Form

Date*
Date Format: MM slash DD slash YYYY
Your Name*
First Last
Are you applying for yourself or for your child?*
- Me
- My child
How many students need tutoring?*
Name of school and grade level for each student*
e.g. 1. Student 1: Green Elementary School - 3rd grade 2. Student 2: Walters Middle School - 6th grade
What is your preferred phone number?*
Your Email Address*
Enter Email Confirm Email
What subject(s) does each student need tutoring?*
e.g. 1. Student 1: Math, History 2. Student 2: English, Science
Tutor(s) you would like to contact*
e.g. 1. Student 1: (name of tutor) 2. Student 2: (name of tutor)
Name of Parent (if the applicant is a student)*
First Last
Email of Parent*
Liability Waiver and Release Form*
Parental Consent*
I, the parent and natural 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 parents or legal guardian.
Phone
This field is for validation purposes and should be left unchanged.