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Scholar's Name
Last Name:
First Name:
Date of Birth:
Current Grade:
Address 1:
Address 2:
City:
Province:
Postal Code:
Main Intersection:
Telephone:
Mobile:
Fax:
Email Address:
Mother's Name:
Father's Name:
School Currently Attending:
Family Doctor/Clinic:
Doctor's Address:
Doctor's Telephone Number:
Ontario Health Card Number:
Emergency Contact Name:
Relationship to Scholar:
Telephone Number:
Medical Information  (e.g. allergies, medical alerts, medication, etc..):
Instruction Required in: (Please Ö )
Mathematics
Language Arts
French
Physics
Biology
Chemistry
Day & Time Preference: (Please Ö )
Monday	Time:
Tuesday	Time:
Wednesday	Time:
Thursday	Time:
Friday	Time:
Saturday	Time:
Sunday	Time:
How did you hear about Scholars Academy Tutoring?
Do You Want To Complete Your High School Credit Courses Online?
Hours of Operation vary. Confirm operating times for this Academy.
For more information contact us at 416-503-0045 or email info@scholarsacademytutoring.com