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The Study Lounge Scholar Enrollment Application

The Study Lounge

Scholar Enrollment Application

Learn. Grow. Succeed.
Welcome to The Study Lounge!

Thank you for choosing us to partner with your family. This enrollment application helps us learn more about your scholar so we can create a personalized Academic Success Plan. Please complete each section carefully. All information is kept confidential.

Section 1: Parent/Guardian Information

Parent/Guardian Name

Relationship to Scholar

Phone Number

Email Address

Home Address

City

State

Zip Code

Preferred Method of Contact

A
B
C

Section 2: Scholar Information

Scholar Full Name

Upload Scholar Photo

Date of Birth

Current Grade

Current School

Teacher’s Name

Favorite Subject

Subject They Need The Most Help With

Section 3: Academic Information

Current Grades

What are your scholar’s greatest academic strengths?

What academic challenges are they experiencing?

Has your scholar ever received tutoring before?

A
B

If yes, please explain.

Section 4: Membership Selection

Membership Selection

A
B
C
D
E
F
G
H

Section 5: Consultation Information

Have you already completed your FREE 20-minute consultation?

A
B

Preferred Consultation Method

A
B
C

Preferred Days

Preferred Time

A
B
C

Section 6: Emergency Contact

Emergency Contact Name

Relationship

Phone Number

Authorized to Pick Up Scholar?

A
B

Section 7: Medical Information

Does your scholar have any allergies?

Please list any medical conditions we should know about.

Is your scholar allowed to receive a complimentary snack?

A
B

Section 8: Photo & Media Release

May The Study Lounge use photographs of your scholar for marketing materials, social media, or the website?

A
B

Section 9: Parent Agreement

I understand that completing this application does not guarantee enrollment until registration is complete, the registration fee has been paid, and membership has been confirmed by The Study Lounge.

I understand that memberships require automatic monthly payments.

I understand that cancellation requires a 30-day written notice.

I understand that The Study Lounge provides academic coaching and tutoring services but does not guarantee specific academic outcomes.

I agree to the terms above.

Section 10: Electronic Signature

Parent/Guardian Full Name

Today’s Date

Electronic Signature

Sign Here