Brainiac In-Home Tutoring - Enrollment Form for Online or In-Home Tutoring (Non-Valid)

Enrollment Form for Online or In-Home Tutoring (Non-Valid)

To begin the enrollment process, parents, guardians or adult students must complete our online enrollment form. The information provided allows our team to review your tutorial requests, contact you regarding available tutoring options, payment plans and schedule tutoring sessions or complimentary introductory sessions when applicable.

Submitting the enrollment form does not obligate your family to hire us or purchase tutorial services. Families are welcome to review our services, discuss plan options, and make an informed decision before hiring us.

If you have any questions or concerns, please contact via email at [email protected] or call 248.242.7733.

Note: Based on tutor availability, we will resume limited traveling to select local cities in Michigan and Indiana at a higher rate. If you have two or more children or assisting adult students to enroll, please click on "Add More Children or Adult Students" at the bottom of the form.

Responsible Adult Person or Parent Information

First Name:

Last Name:

Email:

Cell/Home Phone:

Home Address of Tutee/Local Library

City

State/Province

Zip/Postal Code

Country/Region:

Optional SMS Consent Agreement

I/We agree to receive informational and service-related text messages from Brainiac In-Home Tutoring at the mobile number provided regarding enrollment, scheduling, tutoring sessions, invoices, payments, and service updates. Message frequency varies. Message and data rates may apply. Reply "STOP" to opt out or "HELP" for assistance. Consent is not required to submit this form, enroll in services, or purchase tutoring services.

Student information

Child/Adult Student Information

First Name:

Last Name:

School/College Name:

Grade

Tutorial Request/Inquire

Add additional children or adult students