Out of Bounds Education
2014-2015 School Year Registration Form
Student Name ____________________________ Grade _____ DOB ___ / ___ / ___ Counselor ___________________
Student Cell _____ - _____ - _______ Student Email _____________________________________________________
PowerSchool Username _________________________
Parent Name _____________________________
PowerSchool Password __________________________
Parent Email _________________________________________
Home Phone _____ - _____ - ______ Parent Cell _____ - _____ - _______ Preferred Method of Contact ___________
Billing Address _____________________________________________________________________________________
Please Indicate the Type of Session You Desire:
Private Sessions Are Only Available After 4:30 PM
___ Parent Release Tutoring ___ $50/session Red / White 2 3 4
___ Private Tutoring (1:1 Ratio) ___ $60/hour M T W TH F Time: _______
___ Semi-Private Tutoring (2:1 Ratio) ___ $40/hour M T W TH F Time: _______
Does Your Student Require NCAA Approved Independent Study Courses? _____ YES ______ NO
Please Indicate the Subject Area(s) You Would Like to Focus On:
___ Geography *^ ___ Reading ___ Secondary Math I * ___ ACT Prep
___ World Civ *^ ___ Writing ___ Secondary Math II ___ SAT Prep
___ US History *^ ___ English 9 *^
___ Government *^ ___ English 10 *^
___ Secondary Math III
___ Math 1030/1040
___ Health *^
___ PE 10/Fit for Life *^
___ Psychology ^
___ Sociology ^
___ English 11 *^
___ Financial Lit *^
___ English 12 *^
___ Math 1050/1060
___ AP Calculus
___ AP Statistics
___ Biology *^
___ Chemistry ^
___ Physics ^
___ Study Skills
___ Homework Help
___ Other: _____________________
* Indicates a course offered through Utah’s Electronic High School. These courses are free for all students living in the state of Utah and do not require additional payment for course materials.
^ Indicates a course offered through BYU Independent Study. These courses require a fee for course materials, and sometimes, textbooks.

Out of Bounds Education – Policies
• Payment may be made using cash, check, or credit card. Please circle the option you choose below, and you will be billed accordingly.
CASH CHECK CREDIT CARD
• Check payments may be made in person or mailed to: 1912 Sidewinder Drive #207, Park City, UT, 84060. Please make all checks payable to “Out of Bounds Education.”
• There is a $30 fee for all returned checks.
• Payment is due on or before the 1 st of each month and will be for the total amount for the month to come.
• Invoices will be sent out by the 25 th of each month to allow adequate time to arrange payment.
• If payment is not received by the 5 th , a $30 late fee will be assessed for that month.
• A valid credit card number is required before tutoring may begin, regardless of preferred payment type. If payment is not received by the 5 th of the month, and no communication has been made, your credit card will be billed for the outstanding balance INITIAL . ______
Card Type: __________ Card Number: __________________________________________
Exp. Date: _____ / _____ Sec.Code _______ ZIP ___________
• 24 hour notice is required of ALL cancellations. If 24 hour notice is given, a free make up session will be made available to that student. Make up sessions are scheduled at our convenience, including Friday afternoons. If 24 hour notice is not given, there are no refunds or make up sessions. INITAL ______
• All planned absences outside of the Park City School District calendar must be communicated before invoices are sent out for the month. Once invoices go out to clients, they will not be changed and clients will be responsible for the total invoiced amount. INITIAL _____
• Should the need arise to collect past due payment, clients will be responsible for paying all filing and subsequent legal or attorney fees.
• Appropriate school behavior is expected. Students are to respect themselves, their peers, the tutors, and personal and center property. If a student acts out they will be asked to leave the tutoring session.
• If a student is asked to leave a session, no make up session will be allowed and there will be no refund. A meeting may be required for the student to continue receiving tutoring service. INITIAL ______
• Some high school independent study courses are not free, and the cost of the courses and/or required materials is the responsibility of the student and his/her family.
• All questions and comments should be directed to heidi@outofboundseducation.com
I understand and agree to the policies outlined above.
_______________________________________________________
Parent Name
_____________________
Date
_______________________________________________________
Parent Signature
_____________________
Date
Thank you for your business! We look forward to helping your student achieve academic success!