Allergy and Medical Information

Mission:

Through engaged and interactive learning, Back to the Basics Tutoring LLC aims to help increase the knowledge of basic foundational concepts

Vision:

Back to the Basics Tutoring LLC aims to inspire and motivate children to excel academically through engaged and interactive learning by using new approaches to increase their focus and participation in a learning environment. To help develop the children's needs and also build a partnership with parents, families, and communities to best help the children to build their progress and confidence in identified academic areas.

Fill out this form completely and accurately. This form helps ensure we are aware of relevant medical information so that we are able to address any situations that may arise during the program.

Child's Information

Allergies

Medical Conditions

Prescription Medication

Any Other Information

Parent/Guardian Signature

Additional Questions?

Contact Kiyana Mensah

Phone: 414-973-1009

Email: Bck2thebasicstutoring18@gmail.com

If you would prefer, you may download the document below and email the completed document to bck2thebasicstutoring18@gmail.com

(414) 973-1009

12201 W North Ave, Wauwatosa, WI 53226, USA

©2020 by Back to the Basics Tutoring LLC. Proudly created with Wix.com