Registration Form

Parent/Guardian Name :

Student Full Name : *

Email : *

Phone Number : *

Address : *

Grade Level : *

Which areas does your child need to focus on? *

Computation Skills: (abilities to calculate basic addition, subtraction, multiplication and division problems)

Word problems

Reading Comprehension

Decoding: (key skill for learning to read that involves taking apart the sounds in words (segmenting) and blending sounds together).

Word Recognition

Other ________________ (Specify)

Other area that your child need to focus on :

What times work best for tutoring? *

Morning

Afternoon

Evening

Do you need one-time tutoring or ongoing tutoring? *

one-time

on-going

Has your child had tutoring services before? *

Yes

No

If your child had tutoring before, was it useful? Why or Why not? *

Does your child have special needs? *

Yes (Specify)

No

Do you have any questions or concerns? *

Yes (Specify)

No

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Course Registration