Bobby-Tariq Tutoring Center Corp.

160-05 Hillside Ave Jamaica NY 12401

REGISTRATION FORM

Students Information:

First Name: ___________________________ Last Name: ____________________________

Grade: ________ School: __________________________ Email: _____________________

Parents Information:
First Name: ________________________ Last Name: ______________________________

Address: ____________________________________________________________________

Home Phone: ____________________________ Cell Phone: _________________________

Official Use Only:

Program Description: Payment Description:

Program Name/ Subject (s): Total Deal Amount: ________________
___________________________________ Payment: ________________
___________________________________ Due Checks:
Number of classes: _____________
Number of Hours: ______________ Date Amount Paid/Due
Number of Days Per Week: ______
Number of Hours Per Week: _____
Start Date: ____________________
Approximate End Date: __________
Schedule:
Days: ______________________________
______________________________ Comment: __________________________
Time Window: ______________________ ____________________________________

We have reviewed the program costs and understand the billing procedures for the program.
We accept final responsibility for tuition and fees associated with the Program and agree to
make payment in accordance with the Program's published payment schedule. Intending to
be legally bound, we have signed this agreement.

Parent/ Legal Guardians Signature: ___________________________Date: _____________

Students Signature: _________________________________________Date: _____________

Authorized Personnels Signature: _____________________________Date: ____________

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 Bobby-Tariq Tutoring Center Corp.
160-05 Hillside Ave Jamaica NY 12401

PARENT-STUDENT ACKNOWLEDGEMENT AGREEMENT

PHOTO RELEASE FORM

I hereby grant the Bobby-Tariq Tutoring Center Corp. permission to use my likeness in a
photograph, video, or other digital media (photo) in any and all of its publications,
including web-based publications, without payment or other consideration.

I understand and agree that all photos will become the property of the Bobby-Tariq
Tutoring Center Corp. and will not be returned.

I hereby irrevocably authorize the Bobby-Tariq Tutoring Center Corp. to edit, alter, copy,
exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive
any right to inspect or approve the finished product wherein my likeness appears.
Additionally, I waive any right to royalties or other compensation arising or related to
the use of the photo.

I hereby hold harmless, release, and forever discharge the Bobby-Tariq Learning Center
Corp. from all claims, demands, and causes of action which I, my heirs, representatives,
executors, administrators, or any other persons acting on my behalf or on behalf of my
estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHIOTO RELEASE. I AFFIRM

THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF
AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY
PARENTS/GUARDIANS AS EVIDENCED BY THEIR SIGNATURES BELOW.

I ACCEPT:

Print Name: ______________________________

Signature: ______________________________ Date: __ / __ / ____

If under 18, parent or legal Guardian must sign as parent/guardian.

Parent/ Guardian Signature: ______________________________ | Date: __ / __ / ____