Total College Prep - Private/Semi-Private Lesson Registration Form -- Academic/AP Tutoring (Checking)

Private/Semi-Private Lesson Registration Form -- Academic/AP Tutoring (Checking)

Welcome to Total College Prep! Let's get started by enrolling your student in our private lessons today!

First Name

Last Name

Mobile Phone

Address

City

State

I would like my academic tutoring sessions to be at the following location(s):

ACH - Name on the account

ACH Routing Number

ACH Account Number

ACH- Your Billing Address, City, State, Zip

Payment Agreement -- Academic Tutoring I agree that my account/card will be charged $80 - $125/hour for each private lesson at our McKinney, Prosper, North Plano, Frisco, and Allen locations, as well as lessons done virtually. Contact us for specific quotes correlating to level of academic services/rigor.

Payment Authorization -- Academic Tutoring * I agree for Total College Prep to authorize scheduled charges after each session to my checking account or credit card. I understand that I will still be charged for the cost of my lesson if I fail to cancel my private lesson within 24 hours of its scheduled time. A receipt for each payment will be provided to me. I understand that no prior notification will be provided unless the date or amount changes, in which case I will receive notice from TCP at least 10 days prior to the payment being collected. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify Total College Prep in writing of any changes in my account information or termination of this authorization at least 30 days prior to the next billing date. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. For debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of a Checking Account Transaction being rejected for Non-Sufficient Funds (NSF) I understand that Total College Prep may at its discretion attempt to process the charge again within 30 days, and agree to an additional $35 charge for each attempt returned NSF which will be initiated as a separate transaction from the authorized recurring payment. I acknowledge that the origination of electronic checking account transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this bank account and will not dispute these scheduled transactions with my bank; so long as the transactions correspond to the terms indicated in this authorization form.

Whom can we thank for referring you (Google, friend, organization, website, former client, etc.)?

Cancellation Policy - You may cancel or reschedule, at no additional cost, any session as long as you notify us by email at least 24 hours before your scheduled session. A $100 fee will be charged for cancellations made with less than 24 hours notice.

Text Opt-In/Opt-Out By providing your phone number, you consent to receiving text messages to confirm your lesson time/date or to communicate schedule changes. You may opt-out at any time by texting “STOP” to 972-587-5005. Message and data rates may apply.

I understand that if I or my student does not cancel the lesson 24 hours prior to the lesson. for any reason, that I am responsible for and will be charged the full amount for that lesson. I understand I will be charged for lessons that are not cancelled within 24 hours of the scheduled lesson time.

Student

First Name

Last Name

Mobile Phone

School Name

What grade is your student in?

What subject(s) will your student be focusing on?

Is there anything about your student that we should know?

In what year will your student be graduating?

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