Parent / Student Registration — Viking Education Academy

Student information

Student first name *Student last name *Date of birth *Grade level *

Medical conditions or allergiesCurrent skill level & challenges

Primary goals of tutoring

Best times for lessons

Earliest morning timeEarliest PM time

Parent / Guardian

First name *Last name *

Street address

CityStateZip code

Phone *Email *Relationship to student

Emergency contact

Full namePhoneRelationship

Policies (please read and acknowledge all)

Policy 1 — Tuition

All tuition payments are processed monthly by automatic credit or debit card charges. Tuition does not include any retail teaching materials such as books. Tuition may be subject to revision based on CPI.

I understand and accept Policy 1.

Policy 2 — Cancellations, missed lessons, and makeups

The Academy will attempt to provide a substitute teacher for any lessons a teacher misses. If unavailable, a private makeup lesson will be scheduled. If a student/parent cancels a lesson less than 24 hours before it begins, the lesson is charged in full. If canceled within that 24-hour window, the student may attend a make-up lesson if available. If the student is late, the tutor will wait 15 minutes and then mark absent unexcused (no make-up).

I understand and accept Policy 2.

Policy 3 — Discontinuing lessons

To discontinue lessons and charges, complete the withdrawal form before the 15th of your last month. Tuition is not prorated for the last month. Students are responsible for the last month's tuition whether or not they attend.

I understand and accept Policy 3.

Policy 4 — Average of four lessons per month

Monthly tuition (when offered) is based on a 48-week year. We close four weeks for holidays. Long months may have five lessons; short months (e.g., Nov/Dec) may have three; most months have four. Tuition is the same each month.

I understand and accept Policy 4.

Policy 5 — Summer vacation

The Academy operates year-round and does not close for the summer. If you plan an extended vacation and want to resume after, cancel the lessons you'll miss and resume upon return. Payment for lessons delivered prior to the break remains due at month's end.

I understand and accept Policy 5.

Policy 6 — Care of students

The Academy is not responsible for providing before/after care. Parents of children under eight must remain in the lobby unless otherwise agreed. Students should not be left for excessive periods before/after lessons and must wait inside for pickup. The Academy assumes no responsibility for children who leave unaccompanied.

I understand and accept Policy 6.

Policy 7 — Open door policy

Parents are always welcome to sit in on lessons. During lessons, parents should not comment or interfere with instruction.

I understand and accept Policy 7.

Policy 8 — SMS and email communication

By submitting your cell phone number and email, you consent to receive updates, scheduling information, and notifications via SMS and email. Message frequency may vary. Standard message/data rates may apply. Opt out of SMS by texting STOP; unsubscribe from emails via the links provided.

I understand and accept Policy 8.

Policy 9 — Liability

The parent or legal guardian is responsible for any damage to devices or equipment caused by the Student. Parent/Student (if adult) is expected to reimburse the cost of repair or replacement.

I understand and accept Policy 9.

I have read, understood, and acknowledge the policy terms outlined above.

Signatures

Policy acknowledgement *

Participant waiver and release for minors

I understand and acknowledge that the activity during tutoring, generally very safe, may pose risks to my child. I (we), as parent(s) or guardian(s) of the minor, do hereby, for my child, myself, my heirs, executors, and administrators, release and forever discharge the Academy and all officers, directors, employees, agents, and volunteers of the company, acting officially or otherwise, from any claims, demands, actions or causes of action which in any way arise from the minor's participation in all tutoring activities. To the best of my knowledge and belief, I certify that said minor is in good health. In case of illness or accident, permission is granted for emergency treatment to be administered. It is further understood that the undersigned will assume full responsibility for any such action, including payment of costs.

Participant waiver signature *

Image & audio/video recording waiver

At the Academy, we periodically capture video and audio recordings, as well as photographs, during both in-center and online lessons. This material may be utilized for features such as Student of the Month, Picture of the Day, our newsletter, and other internal educational purposes. If you consent to the use of these images and recordings, please sign below.

Image & A/V waiver signature *

Parent release for teacher communication

I, the parent/guardian, authorize the tutor assigned by Viking Education Academy to communicate directly with my child's teacher(s) regarding their academic performance and areas of struggle. I understand this may involve discussing academic records, classroom behavior, and other relevant information to improve learning outcomes. Information will be used solely to enhance tutoring and treated confidentially.

Teacher communication release signature *

How did you hear about us?

Word of mouthOnline searchSocial mediaFlyer / poster

Other

Day	AM	PM
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday