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Allergy and Medical Information



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


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


Medical Conditions

Prescription Medication

Any Other Information

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Additional Questions?

Contact Kiyana Mensah

Phone: 414-973-1009


If you would prefer, you may download the document below and email the completed document to

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