erin powers education therpaist
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Erin Powers M.Ed BCET
Educational Therapist
Board Certified
650-644-7463

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Contract for Services

I, __________________________ the parent/guardian of ________________________ agree that my child ____________________________ will receive educational therapy services at a rate of $125.00 per 60-minute session.

It is understood that these fees will be applied to all professional services including, but not limited to: parent conferences, email correspondence, and phone calls with parents that extend over 15 minutes.

Payment is always due on or before the first of the month, for the upcoming month.

Payment may be made by check or Venmo. If payment is not delivered in person, checks may be mailed to:

840 Coleman Ave. #9, Menlo Park, CA 94025
or use Venmo: @xxxxx

There is a $25.00 late fee for payments over 5 days late. If payments fall more than one month behind, all sessions will be canceled and the space relinquished.

In the case of illness, sessions must be cancelled with 24-hour notice. If proper cancellation does not occur there will still be a session charge and no make-up lesson will be obligated. In order to respect everyone’s health, no sessions will be conducted in person when either party is sick or shows symptoms of being sick. The 24-hour policy still applies.

A strong relationship is formed between tutor and student. Abrupt termination of services damages that relationship and can be hurtful to a child. Thus, when parents decide that it is time to end services for any reason, two weeks from the day of notice is required. This is to allow time to appropriately close sessions, setting the student up for success. If services are prematurely terminated by the client there will be a charge equal to two tutoring sessions.

With my signature, I guarantee prompt payment for educational therapy services rendered by Ryan Powers. I agree to the financial terms and policies stated above.

 

Printed Name: _______________________________

 

Date: ____________________________

 

Signature: ___________________________________

 

Home Phone #: ____________________

 

Relationship to Child: __________________________

 

Cell phone: ________________________

 

Address: ________________________________

 

Email: ____________________________

            

______________________________________

 

             

______________________________________

 
   

 

In case of Emergency Contact:

 

In case of Emergency Contact:

____________________________________ 

____________________________________

 

Cell phone #: _________________________

 

Cell phone #: _________________________

 

Relationship to Client: ____________________________

 

Relationship to Client: ____________________________