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    Which of these, if any, applies to the student? Foster or adopted child, IEP, processing disorder, 504, hospital/homebound, anaphylaxis, or any other physical/mental disability.

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    Please READ and ACCEPT the terms BELOW before submitting the form.

    Revised 2-10-21
    IMPORTANT- PLEASE READ CAREFULLY: This Student Agreement (this “Agreement”) is made by and between the student and the parent(s) or legal guardian(s) (those who are involved with setting up tutoring, those paying for tutoring, parents or legal guardians are one and the same for the purposes of this agreement and hereinafter referred to as “Guardian” or “Parent”) of the student identified in the web box connected to this Agreement and CogniTutor, LLC, a Florida limited liability company (“CogniTutor"), located at 514 Charlotte Road, Auburndale, FL 33823, and is effective as of the date contained on the attached box (the “Effective Date”).
    In consideration of the mutual covenants and agreements herein, and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, and intending to be legally bound, the parties agree as follows:
    1. Enrollment in Tutoring. Guardians hereby engage CogniTutor to provide tutoring services (the “Tutoring Sessions”) to the Student at a time, location, and frequency to be mutually determined by the Parents, Student, and CogniTutor, pursuant to the terms of this Agreement.
      1. Scope of the Tutoring Sessions. The Tutoring Sessions will be provided to the Student in accordance with the type of tutoring requested by the Student or Parents.
      2. Absences and Cancellations. The Guardian or Student is expected to provide notice of intent to cancel the tutoring session at least six (6) hours in advance. After the first cancellation or “no-show”, the Guardian will be charged an amount equal to the lesser of the entire Tutoring Session or 1 hour of tutoring, unless payment is being made by a CogniTutor Partner. If a Guardian or Student cancels a Tutoring Session at least six (6) hours or more prior to the scheduled start time, the tutor will attempt to schedule a makeup session with the Student. In the event CogniTutor must cancel a Tutoring Session for any reason, Guardians will be notified and the Tutoring Session will be rescheduled.
    2. Session Prices. Parents are jointly and severally liable for the price of session agreed to at the time the first session is scheduled in the CogniTutor system, unless payment is being made by a CogniTutor Partner.  Prices vary depending upon the type of tutor and the lesson type and are subject to change at any time upon prior notice to Guardians or CogniTutor Partner, as applicable. Guardians of individual students not affiliated with a CogniTutor Partner must provide credit card information to CogniTutor and hereby authorize CogniTutor to automatically process payments after the completion of each Tutoring Session.
      1. Late Fees and Penalties. CogniTutor assesses a late charge of ten percent (10%) on any payment not received by the tenth (10th) day after the date of invoice.  In addition, one or more late payments, at the sole discretion of CogniTutor, may result in termination of the Student’s enrollment.
      2. Returned Check Fee. If a check is returned to CogniTutor for any reason, a thirty-five dollar ($35.00) processing fee will be assessed.
      3. Refunds. In the event Guardians and Student are unhappy with the tutor assigned to the Student and notify CogniTutor within 48 hours of the first Tutoring Session, CogniTutor will assign a new tutor to the Student, and the Parents or CogniTutor Partner, as applicable, will receive a credit that will be applied to the first Tutoring Session with the new tutor.  Parents and Student have a 30 day trial period in which CogniTutor will refund any pre-paid amounts for scheduled Tutoring Sessions, provided such Tutoring Session is not scheduled to begin less than 24 hours from the time CogniTutor receives notification of request for such refund. After the first 30 days, there will not be any refunds for pre-paid amounts.
      4. CogniTutor offers a referral incentive to our students. When a new student, referred by an existing student, signs up for at least 3 tutoring sessions, the referring student will receive a 20% discount on their next 3 sessions (cannot be applied to previously bill sessions).
    3. Term and Termination. This Agreement shall continue on a month-to-month basis unless terminated by Parents or CogniTutor.
      1. Parents may terminate this Agreement by giving CogniTutor ten (10) business days’ advance written notice. For example, for a Tutoring Session scheduled to take place on October 11, notice must be sent on or before October 1.
      2. CogniTutor may terminate this Agreement upon immediate written notice to Parents in the event that the Student and/or Parents fail to follow CogniTutor’ policies and rules. In the event of termination by CogniTutor, no refund will be issued.
    4. Independent Contractor. The parties understand and agree that the relationship of CogniTutor to Parents and the Student and CogniTutor Partner, as applicable, is that of an independent contractor.  CogniTutor retains full independence in exercising judgment as to the manner in which the Tutoring Sessions are provided.
    5. Representations, Warranties, and Covenants of Students and Parents.
      1. Location. Parents represent and warrant that the location selected for the Tutoring Sessions, if other than online or at a public location, such as a library, is safe and free from potential hazards.
      2. Behavior. Parents agree to supervise and monitor the behavior of Student and to ensure that Student is at all times courteous and respectful to tutor.  Student and Parents agree at all times to be courteous and respectful to tutor.  If Student or Parents have complaints about tutor, such complaints should be addressed directly with CogniTutor.
      3. Assignments. Students and Parents agree that Student will make every effort to complete the work assigned by the tutor to be completed prior to the next Tutoring Session.
      4. Test Scores and Grades. Students and Parents agree to report to tutor all test scores, test results, and grades for the subject being tutored in order to assist tutor in tracking Student’s progress.
    6. SAT/ACT Higher Score Guarantee.
    If you meet one-on-one with your CogniTutor instructor and your official SAT test score (Math, Reading and Writing combined) or your official ACT test score (English, Math, Reading and Science composite) does not improve by 60 points or 2 points respectively, you may be eligible for the SAT/ACT Higher Score Guarantee in the form of 3 sessions one-on-one for 1.5 hours each. In order to qualify for the Higher Score Guarantee, students must:
    • Complete at least 20 hours of one-on-one ACT or SAT test prep with your CogniTutor instructor
    • Complete all of the weekly assigned homework (prior to your course expiration date or official test date, whichever is earlier)
    • Complete CogniTutor pre-assessment (the baseline score) before tutoring begins
    • Complete at least 5 practice tests before the official test including 2 timed, graded tests on a Saturday 8 AM until 12 PM simulating the real test and go over these tests with your tutor
    • take the official SAT or ACT on the next official test date following the final session of your applicable program
    • Submit official score reports to and request the repeat program within 1 month after the official SAT or ACT test scores are released
    How CogniTutor measures improvement for the Free Course Guarantee

    Your starting score (the score you got on the ACT or SAT before taking a CogniTutor SAT/ACT preparatory course for the first time) will be determined as follows:
    • If you have taken an official SAT or ACT no more than 6 months prior to the start of your CogniTutor course, your starting score will be your prior official SAT or ACT composite score.
    • If you have taken an official PSAT no more than 1 year prior to the start of your CogniTutor course, your starting score will be the SAT or ACT equivalent of your PSAT score.
    • If you have not taken an official SAT or ACT test 6 months or less before the start of your CogniTutor course, your starting score will be the results from your first assessment practice test in our program. CogniTutor courses do not always start with a first assessment practice test (the courses differ slightly depending on specific student’s needs). It is the responsibility of the student and/or parent to ensure the student has a valid starting score.
    We will compare your starting score with the results of your score on the official test you take on the next official test date following the final session of your CogniTutor SAT/ACT course. Eligibility for the above Free Course Guarantee is limited to students whose starting score is 1330 or below for the SAT and 30 or below for the ACT.
    For all other subjects and tests besides the SAT and ACT:
    At all times, CogniTutor and its tutors will act in good faith in the best interests of the Student, and will prepare for and conduct Tutoring Sessions under this Agreement with integrity and due care.  However, CogniTutor does not and cannot guarantee results, including but not limited to favorable test results, scores, or grades, or warrant the results of its Tutoring Sessions in any way.  CogniTutor makes no warranties, either expressed, implied, or statutory as to any matter whatsoever, including without limitation, the performance, results, fitness, Student improvement or that the Tutoring Sessions will have a positive impact on the Student’s performance in class or on tests.
    1. Release and Waiver of Liability. Parents, on behalf of themselves and the Student, as well as their successors, assigns, agents, and representatives, hereby release and forever discharge CogniTutor, its legal representatives, its assigns, and those acting with its authority and permission (the “Released Parties”), from and against any and all claims, demands, actions, complaints, suits, or other forms of liability arising out of any accident, injury, loss of property, or any other circumstance or incident that may occur during or as a result of the Student’s participation in the Tutoring Sessions. In no event shall CogniTutor’s aggregate liability arising out of or related to this Agreement, whether arising out of breach of contract, tort, or negligence exceed the amounts paid to CogniTutor by Student.
    2. Indemnification. Parents hereby agree to indemnify and hold harmless the Released Parties from and against liability for all claims, losses, damages, and expenses, including reasonable attorneys’ fees and costs that arise out of or are related to: (a) actions or omissions of Parents and/or the Student; or (b) Parent’s and/or the Student’s failure to comply with local, state, and federal laws; or (c) Parent’s and/or the Student’s failure to comply with the terms of this Agreement or the policies and procedures of CogniTutor.
    3. Intellectual Property Rights. Parents and Students acknowledge and agree that all intellectual property rights and ownership to the Tutoring Sessions, curriculum, materials, processes, methods, designs, analyses, trademarks, service marks, and other indicia of origin, writings, audiovisual works, concepts, drawings, reports, and all similar, related, or derivative information or works, belong to CogniTutor or its licensors and may not be copied, reproduced, resold, published, transferred, or distributed, in whole or in part, without the prior written consent of CogniTutor.
    4. Force Majeure. Anything in this Agreement to the contrary notwithstanding, CogniTutor is excused from performing any of its obligations pursuant to this Agreement in the event of a civil commotion, warlike operation, invasion, rebellion, hostilities, military or usurped power, sabotage, government regulations or controls, inability to obtain any material, utilities, service, act of God, or through some other cause beyond the control of CogniTutor.
    5. Student Media Release. Parents hereby authorize the videotaping, recording, and/or photography of the Student and the use of the Student’s name, likeness, voice, creative work, test results, scores, and other improvements for any commercial purpose without further compensation whatsoever of any kind as a result of such use.  For images published, the Student’s last name, home address, or telephone number will not appear with such work or photo, unless a special circumstance arises, and specific permission has been granted by Parents. By using CogniTutor’s service, Parents do authorize CogniTutor to use any photograph, videotape, audio tape, name, likeness, creative work, test results, scores, voice and other improvements of the Student for the purposes listed in this section.
    6. General Provisions. This Agreement is governed by the laws of the state of Florida. Exclusive venue for any action to enforce or interpret this Agreement shall be the state or federal courts located in Polk County, Florida. This Agreement is the complete and final expression of the agreement of the parties with respect to the subject matter of this Agreement. There are no other understandings, representations or agreements, oral or written, between the parties that vary or contradict this Agreement. Any amendments to this Agreement are not valid unless made in writing and signed by both parties. The terms of this Agreement are binding upon the parties hereto, their heirs, successors, assigns, and personal representatives.
    Revision: 2-10-21
    CogniTutor, LLC takes your privacy seriously. We want you to know that you can use our Website and Services with confidence. This policy covers how we treat personal information that CogniTutor collects and receives, including information related to your registration with the CogniTutor organization either as a Tutor or as a Student.
    Why we need your personal information:
    We need to collect some personal information from you to set up your account with us. Here are some of the things we need your personal information to be able to do:
    • Make your tutoring sessions personal
    • Store all of your past sessions so you can review them at any time
    • Complete your purchases and payments
    • Contact you about your account
    • Ask you for your feedback to help make our service better
    • Respond to your email requests for information and/or customer service
    You trust us with your Personal Information. So, we do everything we can to make sure your information is safe in our systems. Some things we will NOT do are:
    • We will NOT sell your personal information to anyone
    • We will NOT send you newsletters or promotional mail or email if you tell us not to
    Types of Information Collected
    We will collect information such as your name, address, email address, other contact information, payment information, surveys and other information input into the Website; automatic information (data resulting from your activity such as transaction information, IP address, log in, passwords and browsing activity); mobile information (location services); and information from other sources. We may also gather additional information such as the type of device and browser you are using, the IP address of your device, information about your device’s operating system, and additional information associated with your device and browsing activity. We may also gather information collected through cookies, tags, and other technologies.
    When your information will and will NOT be released to a third party
    • We will NEVER sell your information to a third party.
    • We may send promotions via mail to our Members, but Members retain the right to opt out of receiving these promotions.
    • We share your personal information with the vendors (companies) that help us process transactions, such as charging your credit card when you make purchases.
    • If your parents and/or your school pay for/subsidize any of your tutoring, we may share your Personal Information with them at their request. This may include the content of any (or all) of your tutoring sessions (transcripts) as well as the written comments you leave in post-session surveys. For the purposes of our Privacy Policy, your school is considered to be subsidizing your tutoring if it has negotiated a special price or trial offer for its students. On the other hand, if you pay us for your own account, without the involvement of your parents or your school, we will not share your Personal Information with them.
    • If we have reason to believe that disclosing your Personal Identification is required by law, is reasonable to protect someone from possible injury, or as part of a internal or external legal investigation, we may do so.
    • Periodically, we may encourage our Members to complete surveys to help us provide better services. Your personal information will remain confidential even if a third party conducts the survey.
    Additional Technologies
    We may also use additional technologies such as pixel tags, web beacons, and clear GIFs, and may permit our third party service providers to use these technologies. We use these technologies for purposes such as measuring the effectiveness of our advertisements or other communications, determining viewing and response rates, and determining which offers to present to you on our own or on third party sites.
    Credit Card Policy
    While we make every effort to ensure the integrity and security of our network and systems, we cannot guarantee that our security measures will prevent third-party "hackers" from illegally obtaining this information.
    In the unlikely event that you experience unauthorized use of your credit card, promptly report the fraudulent activity to your credit card company. Under the Fair Credit Billing Act, you are only liable for the first $50 of the fraudulent charges. Please check with your credit card company to verify specific terms and conditions.
    Online Advertisements
    We occasionally display online advertisements on our Website and in our newsletters and alerts. We share aggregated and non-identifying information about our Visitors and Members collected through the registration process as well as through online surveys and promotions with these advertisers. Additionally, in some instances, we use this aggregated and non-identifying information to deliver tailored advertisements. For instance, an advertiser might tell us the audience they want to reach (for example, males between 25 and 55 years of age) and provide us with an advertisement tailored to that audience. Based upon the aggregated and non-identifying information we have collected, we may then display the advertisement to the intended audience. However, we do not share personal information about Visitors or Members with these advertisers to be used for other purposes.
    Responses to Email Inquiries
    When Visitors or Members send email inquiries to us, we use the return email address to answer the email inquiry we receive. We do not use the return email address for any other purpose and do not share the return email address with any third party.
    Our Commitment to Data Security
    Services and websites we sponsor have security measures in place to protect the loss, misuse, and alteration of the information under our control. While we make every effort to ensure the integrity and security of our network and systems, we cannot guarantee that our security measures will prevent third-party "hackers" from illegally obtaining this information.
    Changing or Removing Your Information
    Upon request, we provide site visitors with access to all information (including proprietary information) that we maintain about them. Upon request, we offer visitors the ability to have any and all inaccuracies corrected in contact information, financial information, unique identifiers, transaction information, communications that the consumer/visitor has directed to the site, and other aggregate and non-aggregate information related to the consumer/visitor. You may request that CogniTutor no longer store whatever information is collected about you by contacting CogniTutor using any of the methods listed below.
    Contact CogniTutor
    Leave a comment on
    Changes to This Policy
    From time to time, we may use customer information for new, unanticipated uses not previously disclosed in our privacy notice. Please check these terms frequently, as they are subject to revision by CogniTutor from time to time. If you feel that this site is not following its stated information policies, or if you have any other questions or concerns regarding these privacy policies, you may contact us using any of the methods listed above.
    Links Policy
    We may include links to web sites outside of our web site. These links are provided to offer users further relevant information, which you may wish to explore.
    We are not responsible for the content of external web sites. The inclusion of a link to a third party web site from our website or service should not be understood as an endorsement or authorization of any content, concepts, offers, advertising or any other content or information. Many of these other websites may send their own cookies to users, collect data, or solicit personal information and we do not guaranty the security of any information that you may disclose.
    Disclosure of Your Information.
    We may disclose aggregated information about our users, and information that does not identify any individual, without restriction.
    We may disclose personal information that we collect or you provide as described in this privacy policy:
    1. To our subsidiaries and affiliates.
    2. To contractors, service providers, and other third parties we use to support our business and who are bound by contractual obligations to keep personal information confidential and use it only for the purposes for which we disclose it to them.
    3. To a buyer or other successor in the event of a merger, divestiture, restructuring, reorganization, dissolution, or other sale or transfer of some or all of our assets, whether as a going concern or as part of bankruptcy, liquidation, or similar proceeding, in which personal information held by us about our Website users is among the assets transferred.
    4. To fulfill the purpose for which you provide it. For example, if you give us an email address to use the "email a friend" feature of our Website, we will transmit the contents of that email and your email address to the recipients.
    5. For any other purpose disclosed by us when you provide the information.
    6. With your consent.
    We may also disclose your personal information:
    1. To comply with any court order, law, or legal process, including to respond to any government or regulatory request.
    2. To enforce or apply our terms of use and other agreements, including for billing and collection purposes.
    3. If we believe disclosure is necessary or appropriate to protect the rights, property, or safety of CogniTutor, our customers, or others. This includes exchanging information with other companies and organizations for the purposes of fraud protection and credit risk reduction.
    Your California Privacy Rights
    If you are a California resident, California law may provide you with additional rights regarding our use of your personal information. California's "Shine the Light" law (Civil Code Section § 1798.83) permits users that are California residents to request certain information regarding our disclosure of personal information to third parties for their direct marketing purposes. To make such a request, please send an email to
    No Warranties
    We do not warrant that our website will operate error-free or that our web site or server is free of computer viruses and other harmful components. If your use of our website results in the need for servicing or replacing equipment or data, we are not responsible for those costs or any related damage.
    Copyright Information
    Our web site and all of its content are copyrighted by CogniTutor, LLC and protected by U.S. and international copyright laws. The compilation of content on our website is the exclusive property of CogniTutor, LLC and may not be used for any purpose other than browsing, and using the services and information provided for your own private use. You are only permitted to use our website as expressly authorized by us. Nothing in this Privacy Policy transfers any express or implied right, title, or interest in our web site to you.
    Terms of Use, Arbitration and Governing Law
    If you have any concern about privacy at our Website or from our Services, please contact us with a thorough description, and we will try to resolve it. Our business changes constantly, and our Privacy Policy and the Terms of Use will change also. We may e-mail periodic reminders of our notices, terms and conditions, but you should check our Website frequently to see recent changes. Unless stated otherwise, our current Privacy Policy applies to all information that we have about you and your account.
    The terms and conditions of this Privacy Policy and the agreement it creates, shall be governed by and interpreted according to the laws of the State of Florida without applying the State's conflict-of-law principles). We reserve the right to bring any civil action in Florida, arising from your violation of the terms and conditions of this Privacy Policy and Terms.
    If any provision of this Privacy Policy is unlawful, void, or unenforceable, it will not affect the validity and enforceability of any remaining provisions. This is the entire Privacy Policy regarding all the matters that have been discussed in the preceding paragraphs.
    Copyright © CogniTutor, LLC, 2014-2024. All rights reserved.

    I have read and understand the above consent form. I certify that I am the student's legal guardian or I am the student and 18 years of age or older, and by signing and dating below, I indicate my acceptance of the Student Agreement.
    Signature: Date:

    By providing your information in this form, you are giving CogniTutor permission to send you marketing communications via email and SMS, as well as emails containing updates about our services, your account(s), and opportunities. We value your privacy and are committed to transparency. Please note that your consent is voluntary, and you can opt out of these communications at any time by responding 'STOP' in reply to our emails or by replying 'STOP' to SMS messages. Your written consent method may include requesting information through email, SMS, or phone call; filling out this form; signing an agreement; or providing consent through our website. If you have any questions or concerns about how your information is used, please contact us at 813-798-7441 or Thank you for choosing CogniTutor.