‘24-’25 Student Forms 2024-2025 Policies 2024-2025 Policies Name of person filling out this form * First Name Last Name Your Email Address * STUDENT INFORMATION Name If different from above First Name Last Name Grade Level/Year * School * POLICIES STUDENT PHONE POLICY * To foster an environment most conducive to learning, I ask that student cell phones remain on silent and be kept away. BY TYPING YOUR NAME BELOW, YOU/YOUR CHILD AGREES TO THIS POLICY. PAYMENT AGREEMENT * 2024-2025 RATES 30 min Zoom check-in: $70 55 min Session: $130 Attendance at meetings/communication with parents/teachers/outside providers beyond 15 minutes a week: $40 each 15 mins Payment will be requested via Venmo and must be completed within 24 hours of receipt. BY TYPING YOUR NAME BELOW, YOU AGREE TO THESE TERMS. STUDENT CANCELLATION AGREEMENT * Please provide scheduling conflicts as far in advance as possible. Every effort will be made to reschedule the session for an alternate date/time. Cancellations (not due to illness or emergency) within 24 hours of the session time will be billed at 1/2 the session rate. A cancellation within two hours of the session time will be billed the full rate. A session will be considered "canceled" if a student has not arrived/signed in after 15 minutes of the appointment time, and will be billed in full. BY TYPING YOUR NAME BELOW, YOU AGREE TO THESE TERMS. INSTRUCTOR CANCELLATION AGREEMENT * Sessions will not be held on days off of school or during student breaks (unless agreed upon). I will let you know well in advance if I will not be available for a session due a conflict/travel. If I need to cancel due to sickness or a family-related issue, you will be notified as soon as possible. Every effort will be made to schedule a make-up session. BY TYPING YOUR NAME BELOW, YOU AGREE TO THESE TERMS. Thank you! 2024 Scheduling Survey 2024 Scheduling Survey Student Name * First Name Last Name Grade Level/Year * School * Session Days + Times * My in-person schedule is below. Please specify the days and times that would work for your child. Sundays 9:30am-1pm (Northbrook home office) Mondays 3pm-7:30pm (Dayhouse in HP) Tuesdays 3pm-7:30pm (Dayhouse in HP) Preferred Start Week * In most cases, I prefer to schedule our first meeting after a student has been in school for at least a week. Please specific the week you are looking to begin sessions. August 25 September 1 September 8 September 15 Shifting Times * I may periodically contact you about shifting your session to an earlier slot if one becomes available due to another student's sickness/cancellation. There is never a requirement to move to an earlier time- this is only if it works for you. Please choose an option to reflect your preferences below. Yes, you may contact me about alternate openings if they become available on a given day. No, do not contact me about alternate openings if they become available on a given day. Thank you! New Student Information New Student Information STUDENT INFORMATION Name * First Name Last Name Grade Level/Year * School * Phone Number (if applicable) (###) ### #### Email Address (if applicable) PRIMARY PARENT CONTACT Name * First Name Last Name Phone Number * (###) ### #### Email Address * SECONDARY PARENT CONTACT Please complete if I will be communicating with both parents. Name First Name Last Name Phone Number (###) ### #### Email Address FINANCIAL RESPONSIBILITY Who is responsible for submitting payments? * Venmo Name * Thank you! Please complete the “2024-2025 Policies” form. Helpful Links Recommended Academic Planner Click here to purchase the "Order Out Of Chaos" planner. EF Overview Click here for a quick overview of EF, from understood.org.