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K-12 Student Enrollment Form

First Name *
Last Name *
(IF “Hispanic or Latino/a” NOT selected in previous question) Are you of Hispanic or Latino/a origin?
Address Line 1 *
Address Line 2
City *
State/Province *
Postal Code *
Address Line 1
Address Line 2
Postal Code

First Name *
Last Name *
First Name *
Last Name *
Information about what services you need:
Does your student REQUIRE a spanish speaking tutor?
Only pick Yes if student does not speak any English
Is there an IEP or 501 Plan in place?
Please share what you believe might be helpful to the tutor in working with you/your student as a learner. Information provided will be confidential.
Availabilities: We do our best to meet your Tutoring needs during the week. Please provide us with information on your students availability for tutoring.
Day (s) of the week
check all that apply.
(We tutor Monday through Friday 9-5:30 with afterschool tutoring occurring usually at 3:30 and 4:30. Daytime tutoring occurs on the hour 9-3pm) Please indicate all times available.
Release of Student Records Informed Consent Form
Photograph and Video Release
I hereby grant the Estes Park Learning Place and its affiliates permission to use photographs, video and/or audio. These photographs, video and/or audio may be used without identification by name in future publicity and communications of the Estes Park Learning Place for an indefinite period of time.
By submitting this enrollment application, you agree to abide by the Tutoring Agreement.
By submitting this application you agree that The Estes Park Learning Place reserves the right to terminate tutoring if we believe it is not the right fit.