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STUDENT APPLICATION

Student Application
Student lives with:
What is your annual household income
Has your student ever been held back a grade?
Is yourstudent enrolled in special education classes?
Does your student have an I.E.P. (Individualized Eudcation Program)?
My student to participate in online tutoring
Northstar Tutoring to access my child's report card and standardized test scores
My child to attend field trips with Northstar Tutoring staff and volunteers
Northstar tutoring to use photos or video of my child to promote Northstar Tutoring
Northstar Tutoring to have access to my student's log-in information to access my student's grades on the DCPS website (Aspen)

Waiver and Release of Liability

  1. In case there is any need for Northstar Tutoring to contact me, I agree to be reachable at the phone number provided above during each tutoring session or other Northstar event that the student attends

  2. Should it be necessary for my child to have medical or emergency treatment while participating in an activity with Northstar, I hereby give Northstar Tutoring personnel permission to use their judgment in obtaining medical services, and I give my permission to the physician selected by Northstar Tutoring personnel to render medical treatment deemed necessary and appropriate by the physician.

  3. All persons participating in activities of Northstar Tutoring are deemed to have waived all claims against Northstar Tutoring, its directors, officers, staff and volunteers for injury, accident, illness or death occurring or by reason of a Northstar related activity. I acknowledge that my child may be exposed to significant risk by participating in Northstar Tutoring activities. I have read and understood the foregoing statement and agree to assume the responsibility stated and waive all claims to the full extent permitted by law. 

 

Your signature below represents an acknowledgment that you have read, understand, and agreed to this waiver and release of liability policies.  

Your Signature

Northstar Tutoring Expectations

  1. The student will attend tutoring each week, on-time, unless he or she is ill or has a school or family commitment. If the student cannot attend for one of these reasons, Northstar Tutoring must be notified in advance. If the student has more than two unexcused absences a semester he/she may be dismissed from the program.

  2. The student will bring homework every week, even if it has been completed, as doing so will yield a more productive tutoring session.

  3. The student must bring their report card to tutoring within 3 weeks of receiving a copy from their school.

  4. The student will attend every tutoring session with a positive attitude and respect towards others. Northstar Tutoring will not tolerate bullying, negative behavior, unwillingness to work or follow directions, or disrespect towards adults and the fellow students.  student will exhibit respectful behavior that will not disrupt the safe and calm learning environment that Northstar endeavors to provide for students. The student will not run, yell, or otherwise harass or distract others during tutoring. 

  5. The student will listen to and follow directions given by a Northstar Tutoring adult.

  6. The student will not yell or curse at, threaten, hit or otherwise harm another student. If he or she harms or threatens someone, suspension will be immediate. 

  7. The student will not bring any form of a weapon to tutoring. Failure to abide by this rule will result in immediate and permanent removal from the program. 

 

I have reviewed Northstar Tutoring's expectations and consequences with my child. He or she understands and agrees to follow them, and I agree to help Northstar Tutoring enforce them. All signatures and initials provided herein are my own and indicate my acknowledgment and acceptance of all terms of this Student Application.

Your Signature

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Empowering Children Through Education

Northstar Tutoring

1419 Columbia Rd. NW

Washington, D.C. 20009

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