Literacy Tutoring Registration Form

Please fill out the form below to register for our One-On-One Literacy Tutoring.

Parent/Guardian's First & Last Name *

Child's First & Last Name *

Child's Age *

Grade completed *

Email Address

Phone

Reading DifficultiesStudent has a specific reading disorderStudent is reading below his/her grade levelStudent is reading at the low end of his/her present grade level

Any other comments you would like to make

Best time when you can be contacted

My child is unavailable for tutoring on the following dates:

What days and times of the week is our child available for appointments (Click all that apply) *Tuesday MorningsTuesday AfternoonsTuesday EveningsWednesday MorningsWednesday AfternoonsThursday MorningsThursday AfternoonsFriday MorningsFriday Afternoons

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