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Learning Matters Registration Form

Please contact us at (615) 739-0547 if you are unable to fill out these forms online. 

Registration Information
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Please select all that apply
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Student Information
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First Name
Last Name
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(mm/dd/yyyy)
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If not listed, select other. If homeschool, select homeschool
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Please select ethnicity of Student/Child

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Primary Parent / Guardian Contact Information

How did you hear about Learning Matters?
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Prefix
First Name
Last Name
Suffix
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Primary Parent / Guardian
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Primary Parent / Guardian

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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code


Primary Parent / Guardian
Secondary Parent / Guardian Contact Information

Prefix
First Name
Last Name
Suffix

Secondary Parent / Guardian Name Mobile


Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country


Secondary Parent / Guardian Work
Emergency Contact Information

First Name
Last Name

Emergency Contact Phone

Terms and Conditions

We are a nonprofit organization. This policy was written in an attempt to fairly serve our clients while providing our teachers with a stable income. Please feel free to contact us at any time to discuss special circumstances. We thank you in advance for adhering to the policy.

Tutoring Payment and Scheduling Policy

If your family has a combined income of less than $75,000 a year, you will qualify for a reduced rate, according to our sliding scale fee schedule, when a copy of your most recent tax return is submitted to us. Client invoices will be prepared on the 15th of each month for continuing students. The invoices will include sessions that have been scheduled for the following month. Should a client need to make any changes to the schedule that are included on the invoice, they are asked to call Learning Matters before the first day of the month to report those changes. Dates will be rearranged or credits will be given. Payment is due by the first day of the month. If you pay by credit card on file, your credit card will be charged on the first of the month, unless other arrangements are made.

Cancellation Policy

Cancellations require a 24–hour notice. Make–up dates will be offered to the client to be used within 60 days. No credits or refunds will be given. Should the teacher need to cancel a session, the client will be offered either a make–up session or a credit. If a client fails to appear for a scheduled session, they will be charged for that session because the teacher will be paid for their time and preparation. Should tutoring be discontinued, any remaining balance will be offered in the form of tutoring sessions, but must be used within 90 days. 

Assessment and Advocacy Payment and Scheduling Policy

If your family has a combined income of less than $75,000 a year, you will qualify for a reduced rate according to our sliding scale fee schedule when a copy of your most recent tax return is submitted to us. An upfront deposit of $300 is required to secure your psycho-educational evaluation. A $150 deposit is required to secure your diagnostic evaluation. At least 24-hour notice is required to reschedule an assessment without losing the deposit. Payment is due at the time service is rendered. Payment may be made by credit card or check.

Collection of Overdue Accounts

Clients are asked to maintain a zero balance at all times. If collection procedures become necessary for an overdue account, you will be required to pay reasonable attorney’s fees and court costs.

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