Expert S.T.E.A.M. Student Registration Form

First Name

Last Name

Address

City

Zip Code

Photo Release Agreement (Y=Agree with terms or N=Do Not Agree with terms) (Optional: See Details Below)*

Limited Liability Release (Y=Agree with terms or N=Do Not Agree with terms) (Required: See Details Below)**

Parent/Guardian Address (For Minors, if different than student)

Parent Phone Number

Email Address

State

Grade Level For The Current School Year (Kindergarten--Grad School)

Name Of School Currently Attending

List The Subject(s) In Which Assistance Is Needed

Billing Policy (Y=Agree with terms or N=Do Not Agree with terms) (Required: See Details Below)***

Cancellation/Tardiness Policy (Y=Agree with terms or N=Do Not Agree with terms) (Required: See Details Below)****

Stude Phone Number (if applicable)

Submit

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* Photo Release (Optional)

I give my permission for Science Unlimited, LLC to use photographs of my child for purposes of publicity or publications, both internally and externally through various media sources, including but not limited to newspaper, magazine, internet and television. Please initial in the box above to agree to the terms.

Limited Liability Release (Required)**

This release is made on the date of the electronic submission by the undersigned. I understand and appreciate that participation in Science Unlimited, LLC’s Summer With A Scientist Program involves potential, although highly unlikely, loss or damage to personal property and bodily injury. In consideration of my child being permitted, to participate in the scheduled activity, I hereby release and hold harmless Science Unlimited, LLC as sponsor, its commissioners, officers, trustees, employees, affiliates and agents (“the “Released Parties”) from any and all actions, damages, claims or demands which my child(ren), their heirs, executors, administrators or assigns may have against the Released Parties. I, the undersigned, have read this release and understand its terms. I realize that this a partial release of liability, and limits, to some extent, my rights to sue in the event of any loss or injury, and I execute it voluntarily and with the full knowledge of its significance. I agree to follow, or cause to be followed, all directions of the activity’s leaders. I, the undersigned, am the parent or legal guardian of the registered participant and enter into the foregoing release on the minor’s behalf. Please initial in the box above to agree to the terms.

** *Billing Policy (Required)

Any tutoring time that exceeds past the time purchased or agreed upon with your tutor will be billed in 30 minute increments. For example: If you purchase a 1 hour tutoring session and your session goes beyond 1 hour (1 minute -30 minutes), you will be billed for an additional 30 minutes of tutoring time. Additional time from 31 minutes-59 minutes past your scheduled time will result in the billing of an additonal hour of tutoring time.

Cancellation/Tardiness Policy (Required)

CANCELLATIONS: 1) If the student/guardian gives more than 6 hours notice of cancellation before the start of the lesson, we will not charge you for the lesson. 2) If the student/guardian gives between 1-6 hours (inclusive) notice of cancellation before the lesson, we reserve the right to charge 50% the rate for the lesson length. When the sessions are purchased as part of a monthly package, 50% of one session (30 minutes) will be forfeited. 3) If the student/guardian gives less than 1 hour notice of cancellation, we reserve the right to charge for the entire lesson at the full rate. When the sessions are purchased as part of a monthly package, 100% of one session (60 minutes/1 hour) will be forfeited. 4) If the student/guardian gives less than 15 minutes notice of cancellation, does not show up at all, or does not show up by 15 minutes after the start of the lesson time, we reserve the right to charge double the full rate for the lesson. When the sessions are purchased as part of a monthly package, the equivalent of two full sessions (120 minutes/2 hours) will be forfeited. 5) If the tutor, misses a lesson with less than 2 hours notice of cancellation, the student/guardian reserves the right to request the next lesson of equivalent length for no fee. When the sessions are purchased as part of a monthly package, the student/parent/guardian reserves the right to reschedule a full lesson (60 minutes) free of charge. This time can be negotiated directly with your tutor.

TARDIES: 1) If a student is 15 or more minutes late, we will charge for the entire length of the actual lesson plus $5 for each minute you're late past the 15 minutes. For example, if your rate is $60/hr and you are 17 minutes late, we will charge you $60 (full rate) + $10 ($5 each for the extra 2 minutes) = $70. When the sessions are purchased as part of a monthly package, the session time will be reduced by the amount of time the student is late. Exceptions or rate reductions may be made for students who provide reasonable advanced notice of tardiness (determined at the owner's discretion). 2) If the tutor is 15 or more minutes late without prior notice (30 or more minutes prior to the start of the lesson), the student/parent/guardian reserves the right to request 50% rate for the length of the lesson. When the sessions are purchased as part of a monthly package, the student/parent/guardian reserves the right to request an additional 30 minutes for that lesson. This time can be negotiated directly with your tutor.