RCLC Tutoring Registration Form (Literacy Corps)
Student's Name: *
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Student's Date of Birth: *
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Parent/Guardian Name: *
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School: *
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Grade: *
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Teacher's Name: *
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My student's main language is: *
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Other languages spoken at home: *
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Address: *
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City: *
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Zip: *
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Phone: *
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Cell phone:
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Email:
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I wish to enroll my student in Literacy Corps Tutoring at the Robinson Community Learning Center. I understand I will be part of the goal-setting for my student. I will try to ensure that he or she will attend all sessions. I will keep all contact information up to date. *
Parent/Guardian Signature:
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Time preference: *
Date: *
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