Mapleton Family Literacy Center Volunteer Registration

Student Name*

First NameLast Name

Parent Name*

First NameLast Name

Parent Phone Number*

Please enter a valid phone number.

Parent Email*

example@example.com

Student Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Does your child like to read?*

YesNo

What are some of your child's interests?*

What school does your child attend?*

What grade is your child in?*

Who is your child's teacher?*

Tutoring services are available during the school year (September through mid-May) on Mondays, Tuesdays, Wednesdays, and Thursdays from 4:00-5:00pm. Your child will receive support and training in reading, comprehension, phonics, and phonemic awareness. Please indicate below which day(s) you would like your child to actually attend, with the understanding that the drop off time will be at 4:00pm and the pick-up time will be at 5:00pm

Please select the day(s) your child can commit to attending (you may select multiple).*

Mondays from 4:00pm-5:00pmTuesdays from 4:00pm-5:00pmWednesdays from 4:00pm-5:00pmThursdays from 4:00pm-5:00pm

Please explain the kind of help your child needs.*

How did you hear about the Mapleton Family Literacy Center?*

I understand that the Mapleton Family Literacy Center's tutoring program is not intended to help my child on a professional level. I understand that if my child needs more attention/help than this tutoring program is able to offer, Mapleton Family Literacy Center reserves the right of refusal before or during my child's participation in the tutoring program. I understand that three missed no-call/no-show classes equals a forfeiture of tutoring service.*

Confirmed

I understand that tutoring is meant to reinforce and support what my child is learning at school and at home, especially for those who are experiencing delays. It is not designed to be my child's main reading instruction, nor is it designed to be the start of my child's reading exposure and experience. In order for the tutoring program to be as effective as possible, participants must be at a minimum of a first grade reading level. I acknowledge that I understand these terms and verify that my child meets these conditions.*

Confirmed

I agree to all terms listed above.*

Date*

Date

Mapleton Family Literacy Center Student Registration