Students – OneLife Tutoring

OneLife Tutoring Students

Are you interested in having your child involved with OneLife Tutoring?
All OneLife Tutoring students are referred to our program by their teachers & the Seattle Public Schools.
OneLife vans can only serve students in the Wedgwood and Lake City neighborhoods in Seattle.

If you would like your child to be tutored:

Parents must complete the Student Registration Form found below.
Once the form has been received by the Director, you child will be placed on our Wait List.
The Director will contact when a tutor is available for your student.

Student Registration Form

Student Information
Student's Name

Student's Birthdate:

School:

Grade:

Classroom Teacher(s):

Teacher email:

Parent/Guardian Information
Name

Email:

Address:

City, State, Zip:

Cell Phone:

Work Phone:

Home Phone:

Transportation
I need for the tutoring van to pick up my child.
YesNo

If Yes, the pick-up address for the van is:

If Yes, the adult at the pick-up address is:

Their phone number:

The adult at the drop-off address is (if different):

Their phone number:

If you are providing transportation, your child will be dropped off at (time):

and picked up at (time):

Special Instructions:

Emergency Information
Emergency contact name:

Emergency contact phone:

Does the child have activity restrictions?
YesNo
If yes, please list:

Medication/allergy concerns:

Permissions
My child has permission to attend OneLife Tutoring for the current school year.
YesNo
My child has permission to be driven to and from OneLife Tutoring by our staff.
YesNo
OneLife Tutoring has permission to seek proper medical attention for my child should the need arise.
YesNo
OneLife Tutoring has permission to photograph my child for promotional purposes.
YesNo

Insurance and Medical Information
Medical Doctor's Name

Medical Doctor's Phone Number

Medical Doctor's Location

Medical Insurance Name

Medical Insurance Group Number

Medical Insurance Policy Holder

Medical Insurance Policy Number

Any other restrictions, details, information, that we should know about?

In the event that I, or my listed contact person, cannot be reached I authorize the administration of emergency medical treatment for my child.
PLEASE READ CAREFULLY - As a parent/legal guardian of the child list on this form I have reviewed the information about the 2023-2024 OneLife Tutoring and give permission for the subject of this release to be involved in the overall activities. I/We have reviewed the rules of the activities and agree that the subject of this release will abide them. I/We also acknowledge that if the subject of the release has to return home early for discipline violations, it will be at my/our expense. I/We understand all reasonable safety precautions will be taken at all times by OneLife Community Church/OneLife Tutoring and its agents during the events and activities. I/We understand the possibility of unforeseen hazards and know the inherent possibility of risk. I understand that in the event medical intervention is needed, every attempt will be made to contact immediately the persons listed on this form. In the event I cannot be reached in an emergency during the activity dates shown of this form, I hereby give my permission to the physician or dentist selected by the activity leader to hospitalize, to secure medical treatment and/or order an injection, anesthesia, or surgery for my child as deemed necessary. I/We agree not to hold OneLife Community Church/OneLife Tutoring, its leaders, employees, and volunteer staff liable for damages, losses, diseases, or injuries incurred by the subject of this form. Your completion of this form means you are "signing off" and giving us permission as stated above.

Type your first and last name in the box to say YES

Date: