** Because space is limited to a maximum of 8 students per week, before sending in this form please call
Lauren at (914) 474-6494
[email protected]
to check availability of the week(s) you're interested in. Thank you!
Information Form
Please print and mail to:
Summer Tutoring & Enrichment
c/o Lauren Talanian
16 Circuit Drive
Stow, MA
01775
Checks payable to Lauren Talanian
Week(s) your child will join us __________________________________________
Student’s name __________________________________________________
Student’s favorite activities: _______________________________________
________________________________________________________________
Parent’s name _____________________________
Parent’s phone Number _____________________
Parent’s email ______________________________
Parent’s home address_______________________
________________________________________________
Does your child have any allergies? _____________________________
In case of emergency, please contact: __________________________
Who is your child’s current teacher?_____________________________
Would you feel comfortable having us contact this teacher so that we can get an idea of your
child’s current skill level, and suggestions for helping them to move forward?_______________
Please feel free to email us with any additional information about your child.
COVID-19 Assumption of Risk, Release, and Waiver of Liability Agreement
RELEASE AND WAIVER.
In consideration of my child(ren) receiving summer tutoring from Tutoring With a Twist, I do hereby forever release, waive, discharge, and covenant not to sue the teachers from any and all damages, injuries, losses, liability, claims, causes of action, litigation, or demands, including but not limited to, those for personal injury, sickness, or death, as well as property damages and expenses, of any nature whatsoever which may be incurred, directly or indirectly, now or in the future, in any way related to COVID-19 and in connection with my participation in the Services or any travel related thereto.
ASSUMPTION OF RISK. I understand that while the teachers have put in place preventative measures to reduce the spread of COVID-19 by following the CDC and district's guidelines, the teachers are not responsible in any manner for any risks related to COVID-19 in connection with our summer learning. I understand that the World Health Organization has classified the COVID-19 outbreak as a pandemic. I further understand that COVID-19 is a highly contagious and dangerous disease, and that contact with the virus that causes COVID-19 may result in illness, significant personal injury, permanent disability or death. I understand that the teachers cannot guarantee that you or your child(ren) will not become infected with COVID-19. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself.
I expressly agree that this Agreement is intended to be as broad and inclusive as is permitted by applicable laws, and that if any portion of this Agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.
_________________________________
Parent’s (or guardian) signature
*A non-refundable deposit of $250 (per session) is due upon acceptance and registration. The balance of
your child’s week(s) will be due on June 1st. Checks payable to Lauren Talanian