in home tutoring - Wellesley, Needham, Newton , Holden

Covid Questionnaire - Parents
This form is for parents and students. Please fill this out accurately and hit submit before each in-home session.

* Indicates required field

Parent's Name *

First

Last

Child's name *

Child's Name *

child's name *

Email address *

Do you or your child have a fever or have either of you experienced a fever within the past 14 days? *

Have you or your children come into contact with a person with a confirmed case of Covid-19 within the past 14 days? *

Have you or your children come into contact with people from 'red zone' cities, surrounding areas or people from neighborhoods with a recent outbreak within 14 days? *

Have you, within the past 14 days, traveled outside the country? *

If you are having in-home sessions, have you taken the precautions to make your tutoring space safe, sanitized, well ventilated, and free from Coronavirus? *

I certify that the information submitted in this form is true and correct to the best of my knowledge. *

check box

Submit Questionnaire

Covid Questionnaire - ParentsThis form is for parents and students. Please fill this out accurately and hit submit before each in-home session.​

Covid Questionnaire - Parents
This form is for parents and students. Please fill this out accurately and hit submit before each in-home session.