Online Tutoring Consent Form

Student Information

Student Name Date of Birth Parent/Guardian Name Phone Number Email Address Grade Subject Area(s) Start Date

Parent/Guardian Consent I give permission for my child to participate in tutoring services with Positive Kids. I understand tutoring is an educational support service and is not therapy, counselling, psychological assessment, special education assessment, or a guarantee of specific grades or academic outcomes.

Student and Family Responsibilities

Tutoring works best when the student attends regularly, participates actively, completes assigned work when needed, and has access to required school materials. Parents or guardians may be asked to share report cards, teacher feedback, learning goals, assignments, or areas of concern so the tutor can support the student effectively.

I understand the student and family responsibilities for tutoring.

Communication

Positive Kids may provide general updates to the parent or guardian regarding attendance, participation, progress, and areas requiring support. Positive Kids will not communicate with the student's school, teacher, doctor, therapist, or other professionals without parent or guardian consent, unless required by law or needed for safety.

I understand the communication statement. I give permission for Positive Kids to communicate with the individual or organization listed below, if needed.

Name/Organization Purpose of Communication Parent/Guardian Initials

Confidentiality

Positive Kids will respect the privacy of the student and family. Information shared during tutoring will be kept confidential, except when disclosure is required by law or necessary for safety. Confidentiality may be broken if there is concern about risk of harm to self or others, abuse or neglect of a child, a legal requirement to release information, or a serious safety concern requiring parent, guardian, or emergency involvement.

I understand the confidentiality statement.

Attendance, Cancellations, and Limits of Service I understand consistent attendance is important for progress and agree to follow Positive Kids' cancellation, rescheduling, and payment policies as provided to me. I understand tutoring does not guarantee specific grades, report card results, school placement, or academic outcomes.

Consent and Signature

By signing below, I confirm that I understand the nature of tutoring services and give permission for my child to participate.

Additional Notes

Parent/Guardian Signature Date

Consent Form

Online Consent Form

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