Tutee Online Registration Form

First & Last name (EX: Kevin Lee)

Birth Date

Month

Day

Year

Grade:

Name of School:

City of School:

Home Address:

Cell Phone:

Email:

How did you hear about us?

If you learned from a CAL GIVE member, please provide the name:

In our program, you will have the opportunity of participating in our Music, English, or STEM programs. Please number each program in order of preference. (Number your most preferred program with a 1/2/3 - “1” being your first choice). You will be assigned to 2 programs. There is unfortunately no guarantee that you will be assigned to your first 2 choices

Music

1

2

3

English

1

2

3

STEM

1

2

3

If you would like to participate in the music program, please check which instrument you own. If you do not own one of these instruments, please check the appropriate box. You must own the instrument you are interested in studying.

Parent/Guardian Information

Name:

Daytime Phone:

Cell Phone:

Email:

The G.I.V.E. program has eligibility requirements based on Annual Household Income. Please indicate the following by checking the appropriate line:

G.I.V.E Code of Conduct

● Keep a positive attitude

● Be willing to learn

● Show respect to others including other students/participants and instructors

● Will follow instructions/rules about using Zoom (i.e. will keep video camera and sound turned on at all times, will stay in view of the camera)

● Complete activities and assignments to the best of your ability

I have read the G.I.V.E. Code of Conduct and understand that if I do not abide by these rules, I may be asked to leave the program.

Name of Student (Please Print):

Date:

Month

Day

Year

Signature of Student:

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Name of Parent/Guardian (Please Print):

Date:

Month

Day

Year

Signature of Parent/Guardian:

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.