Our Location

400 Oakley Av. Lynchburg, VA 24501

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Tutoring/Mentoring Form

“Building Healthy Families for Generational Greatness”

Fill out this form to enroll your child in the program. We will assess your child’s current skills
using the skill assessment form that will also be sent to you and based on that, your child will be matched
with a tutor to help develop and reinforce math and reading skills and any other skill you think your child
needs.

Tutoring/Mentoring Form

Student Information:

Parent/Legal Guardian 1 Information:

Parent/Legal Guardian 2 Information:

Emergency contact information:

School Liaison: If you would like us to work with your child’s class teacher to get academic and
behavioral information and feedback for your child, we would be happy to do that with your
consent.

Permission/Consent to Contact Class Teacher

I hereby give my permission for Generations & Greatness to contact my child’s teachers to monitor and
get feedback on my child’s academic and behavioral progress.

I hereby give permission for my above-named child to participate in Generations and Greatness’s Afterschool and Tutorial Program for Kids. To ensure that my child benefits from this program, I hereby agree to the
following:

  •  To have my child attend every tutoring session and to inform the program director ahead of time on any
    Saturday that my child will not be attending the session.
  •  To communicate any concerns regarding my child’s participation in the program to the program director
    and to respond to communications from G & G in a timely manner.
  • That the service provided is free and that G & G utilizes only trained and vetted volunteers.
  • To waive and release all claims for damages that I may have against G & G and its personnel.
  •  That G & G Tutorial and Afterschool Program will not be held liable for any claims of losses or damages of
    every type, and I will personally indemnify, defend and hold G & G harmless.