Clone of 2025/2026 CALI Center After School Program

1
Child's Name* This field is required.
First Name
Last Name
2
Address* This field is required.
Street Address
Street Address Line 2
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3
Child's E-mail Address* This field is required.Write NONE if no email
4
Male/Female
Male
Female
5
Birth Date* This field is required.
Month
Day
Year
6
Student age* This field is required.
7
Grade* This field is required.
8
Does the student have any learning differences?* This field is required.
Yes
No
9
If yes, Please tell us more
10
Does the student have an IEP?* This field is required.
Yes
No
11
If yes, Please tell us more
12
Please List Any Known Allergies* This field is required.(write NONE if no allergies)
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13
Please provide parent/guardian information.
14
Parent's Name* This field is required.
15
Parent's Email Address* This field is required.
16
Parent's Contact Number* This field is required.
17
Parent Signature* This field is required.
18
Terms and Conditions* This field is required.Please read the terms and conditions. Feel free to print for your records.
19
My Products* This field is required.
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Great Product Name
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Size:Small
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Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
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ORDER SUMMARY
Total costUSD
English Language Arts 1
Tutoring 1 Day Per Week Hourly Rate
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Back
1
1
1 month
English Language Arts 2
Tutoring 2 Days Per Week Hourly Rate
Edit
Back
1
1
1 month
English Language Arts 3
Tutoring 3 Days Per Week Hourly Rate
Edit
Back
1
1
1 month
Mathematics 1
Tutoring 1 Day Per Week Hourly Rate
Edit
Back
1
1
2
SIBLING DISCOUNT
Mathematics 2
Tutoring 2 Days Per Week Hourly Rate
Edit
Back
1
1
2
SIBLING DISCOUNT
Mathematics 3
Tutoring 3 Days Per Week Hourly Rate
Edit
Back
1
1
2
SIBLING DISCOUNT
Science 1
Tutoring 1 Day Per Week Hourly Rate
Edit
Back
1
1
2
2 Months
Science 2
Tutoring 2 Days Per Week Hourly Rate
Edit
Back
1
1
2
2 Months
Science 3
Tutoring 3 Days Per Week Hourly Rate
Edit
Back
1
1
2
2 Months
History 1
Tutoring 1 Day Per Week Hourly Rate
Edit
Back
1
1
2
2 Months
History 2
Tutoring 2 Days Per Week Hourly Rate
Edit
Back
1
1
2
2 Months
History 3
Tutoring 3 Days Per Week Hourly Rate
Edit
Back
1
1
2
2 Months
Writing Workshop
Tutoring 2 Days Per Week Hourly Rate
(Semester Workshop)
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Back
1
1
3 month
ESL/ELL
Tutoring 2 Days Per Week Minimum Hourly Rate
Edit
Back
1
1
3 month
Total cost
20
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