Student's Name *

First Name

Last Name

Parent/Legal Guardian's Full Name *

First Name

Last Name

Phone

(###)

###

####

Racial/Ethnic background *

Hispanic/Latino

Black/African American

White/Caucasian

American Indian/Alaskan Native

Asian

Other

Choose the subjects you are interested in *

Math

Science

Language Arts

Reading

Social studies

When do you want to start? *

Immediately

Next week (from the application date)

In two weeks (from the application date)

I am not sure

How often in a week do you expect to meet *

Once

Twice

More than twice

Tutoring location

At Ekaza (408 9th St SW, Canton, OH 44707)

At the closest public library

Consent to discuss student's progress with teachers

The Student (or Parent) AUTHORIZES the Tutor to contact or communicate with the Student’s school/teachers. It is the Parent’s responsibility to provide appropriate contact information to the tutor. Further, the Parent will need to inform the classroom teacher(s) that he/she would like them to communicate with the tutor. NOTE: Teachers are not obligated to communicate with tutors and may not agree to do so.

Yes

No

Terms and Conditions *

WORK HOURS/DAYS Tutoring days and hours are negotiable upon request. Contact Ekaza for the availability of tutors during school breaks at contact@ekazabtg.org. FEE FOR SERVICES Ekaza extends to the Client the rate of $55/hour per session. Each session includes approximately 50 minutes of tutoring and 10 minutes of additional time (i.e. time spent in “warm-up” activities, reviewing progress, overviewing assignments, stretching breaks, etc.) The decision on how to best use instructional time will be made by the Tutor based on the Student’s individual needs and abilities. Payment is required on the first day of each month, regardless of closure due to holidays. If payment is not received by the fifth day of the month, a $5 late fee will be charged, and Client’s session time will be canceled. Once payment is received, rescheduling will be subject to availability. CANCELLATION OF INDIVIDUAL SESSIONS BY STUDENT The Student may cancel a tutoring session for any reason by giving at least 24 hours prior notice to the Tutor, in which case no tuition fees will be incurred. Cancellation shall be made by phone call or text to (330) 204-8735 or to the assigned instructor or via email at contact@ekazabtg.org. The tutor will acknowledge the cancellation and the time it was received. Session not attended by the student without giving 24 hours prior notice to the Tutor shall be charged at the full rate - $55.00 CANCELLATION OF INDIVIDUAL SESSIONS BY TUTOR The Tutor may cancel a session by giving 24 hours prior notice to the Student, in which case no fees shall be incurred. Where a lesson was pre-paid, the Tutor shall reschedule the appointment at a time agreeable to both parties. LATE ARRIVAL Fees are calculated according to the times stipulated in the schedule and no adjustment shall be made for time lost because of late arrival by the Student. Any lost time because of the late arrival of the Tutor shall be compensated by extending a session by mutual agreement and by such amount of time that was lost. OBLIGATIONS OF THE TUTOR The Tutor undertakes to do all preparation prior to lessons and to structure lessons in such a way as to optimize time for the student's benefit. The Tutor shall keep confidential all student information and contact other parties involved in the student's education only if given written permission by the Student/Parent to do so. The Tutor shall not assign any of his/her duties or obligations under this tutoring contract to a third party without the written permission of the Student. OBLIGATIONS OF THE STUDENT/PARENT The Student/Parent shall undertake to assist the Tutor in identifying problem areas in which the Student needs specific tutoring. The Student agrees that assignments, exercises, or homework form an integral part of tutoring and shall undertake to complete any given assignments by the assigned due date. (If applicable.) STATUS OF THE TUTOR It is expressly understood that the Student retains the services of the Tutor as an independent contractor and not as an employee. The Tutor shall be responsible for his/her insurance and all statutory declarations and contributions regarding income tax. TERMINATION OF SERVICES This tutoring contract may be terminated by either party at any time by giving the other party 14 days prior written notice. MINORS Where the Student is a legal minor, the Parent/Guardian shall enter into this tutoring contract on behalf of the Student and shall accept and agree to all the terms and conditions contained herein on behalf of the Student. PAYMENT REFUNDS All payments received are non-refundable for any reason. NO WARRANTIES While Ekaza is confident in the skills and teaching ability of his Tutors and while we strive for excellence, we make no promises or warranties with regard to the performance of our clients as success requires personal commitment and active involvement of the student in the process. ENTIRE AGREEMENT OF THE PARTIES This agreement supersedes any agreements, either oral or written, between the parties concerning the rendering of services by Ekaza and contains all of the representations, covenants, and agreements between the parties concerning the rendering of those services. Any modification of this agreement will be effective only if it is in writing and signed by both parties.

Photo and Video Release *

I give permission to Ekaza-Bridging The Gap to take photographs and/or videos of my child and allow Ekaza-Bridging The Gap to use such photographs and/or videos of my child for any lawful purpose, including, for instance, such purposes as publicity, illustration, advertising, and web content. I have read and understand the above