Brain-Grow Client Information Form
Please tell us about yourself! This will help ensure we give you the best possible service.
Email
*
Parent(s) First Name
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Parent(s) Last Name
*
Home Address
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Phone Number
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Student First Name
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Student Last Name
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Student Email (gmail preferred)
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Student Phone Number (if applicable)
Age/Grade
School
Educational Needs
Academic/School Tutoring
Test Prep ISEE
Organizational/Study Skills
Test Prep SAT or ACT
Test Prep SHSAT
Other
Preferred Method of Contact
Text
Group Text
E-mail
Phone
Do you prefer zoom, in person, or both?
Has your child ever received Educational Testing? Please e-mail report to Julie@brain-grow.com.
Does your child get testing accommodations? If so, what are they?
How academically intense would you say your child is?
How intense would you like your tutor to be?
Does your child have allergies? If so, what are they?
Please add any additional information about your child's/children's educational needs.
Payment Info
*
Signature
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