Rubrik

Application Form

Parent Application Form for Rubrik Ed

Thank you for your interest in Rubrik Ed! We are excited to help your child achieve their academic goals. Please fill out the form below to provide us with the necessary information to get started.

Student Information

Student's Full Name: *

Student's Date of Birth: *

Student's Grade : *

School Name: *

Subjects/Topics for Tutoring: *

Any Special Needs or Learning Challenges?

Parent/Guardian Information

Parent/Guardian Full Name:

Relationship to Student:

Contact Information:

Phone Number:

Email Address:

Preferred Method of Communication:

Address:

Any Specific Goals for Tutoring?

Additional Information

How Did You Hear About Us?

Any Additional Comments or Questions?

Consent and Agreement

I agree to the terms and conditions of Rubrik Ed

I agree

I consent to my child participating in online tutoring sessions.

I consent

I understand that payment is required before sessions begin.

I Understand

Signature

Date

Next Steps

Once you submit this form, a representative from Rubrik Ed will contact you to discuss tutoring options, schedules, and payment details.

Thank you for choosing Rubrik Ed! We look forward to working with your child.