Tumbarello's Teaching and Tutoring Service
Enlightened Learners of Orange County Registration Form
**Please fill out form and mail deposit as described below (For Classes at Your Home, Please contact Renee Tumbarello first for days and times available before sending in the registration form and deposit)
Parent/Legal Guardian(s) Last Name: ____________________________________________________________________________________________________
Father/Legal Guardian First Name:______________________________________________________________________________________________________
Mother/Legal Guardian First Name: _____________________________________________________________________________________________________
Home Address: _____________________________________________________________________________________________________________________
City: __________________________________________________________________ State: __________________ Zip Code: ____________________________
Home Phone: ___________________________________ Mother"s Cell: ___________________________________ Father's Cell: _________________________
Work Phone: ___________________________________ Email Address(es): ____________________________________________________________________
Father/Legal Guardian First Name:______________________________________________________________________________________________________
Mother/Legal Guardian First Name: _____________________________________________________________________________________________________
Home Address: _____________________________________________________________________________________________________________________
City: __________________________________________________________________ State: __________________ Zip Code: ____________________________
Home Phone: ___________________________________ Mother"s Cell: ___________________________________ Father's Cell: _________________________
Work Phone: ___________________________________ Email Address(es): ____________________________________________________________________
Student Information
Please Fill out one form per student. Code of Conduct form required.
Student Last Name: __________________________________________________________________________________________________________________
Student First Name: _______________________________________________________________________________ MI: _______________________________
Age: ________________________________ Birthdate (M/D/Year): ____________________________________________________________________________
Grade: ___________________________________________________________________________________________________________________________
Does the student have any disabilities or special circumstances ex: (food allergies/ medications ) that you would like to inform the teacher about?__________________
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How does your child learn best? What have you found that helps motivate your child to learn? ________________________________________________________
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Please use back for more information....
Student First Name: _______________________________________________________________________________ MI: _______________________________
Age: ________________________________ Birthdate (M/D/Year): ____________________________________________________________________________
Grade: ___________________________________________________________________________________________________________________________
Does the student have any disabilities or special circumstances ex: (food allergies/ medications ) that you would like to inform the teacher about?__________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
How does your child learn best? What have you found that helps motivate your child to learn? ________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
Please use back for more information....
Name of Class/Day/Time
1. ___________________________________________________________________
2. ___________________________________________________________________
**To reserve your student's place, please include a non-refundable deposit (see registration information for appropriate class) for each class desired. Please make checks payable to Renee Tumbarello. Students who apply to full classes will be placed on waiting list, and your check will be held until a space in the class opens.
Check # _____________________________________________ Date: ___________________________ Amount: _____________________________________
Please mail to:
Enlightened Learners of Orange County
C/O Tumbarello's Teaching and Tutoring Service
P.O. Box 11201
Newport Beach, Ca 92658
If you have any questions please contact Renee Tumbarello at [email protected] or call (949) 836-2609.
