Registration for Summer SWI Word Study
Please complete the form to sign up for our Summer SWI Word Study Session offered through Empower Learning Center. Summer Session runs from June 20 to Aug 3, 2017.
Student Name *
Your answer
Student cell or home phone number (to contact in case student is not signed on to the Zoom session on time). Indicate cell or home *
Your answer
Student's email (if applicable)
Your answer
Student Age *
Your answer
Grade going into Fall 2017 *
Your answer
Child's reading level (if known--approx)
Your answer
Learning Differences/Challenges *
Required
If other, please list
Your answer
If you checked any boxes in the above question, are those documented by testing?
Does your child have any of the following:
School Name
Your answer
Which interventions has your child received in the past?
Tell me a little about your child's experiences with learning.
Your answer
Does your child know how to navigate the computer fairly well?
Parent information
Pleaae provide contact information, etc.
Parent(-s) name *
Your answer
Phone number (home, cell) *
Your answer
Address *
Your answer
Parent email: *
Your answer
Will parent attend the tutoring sessions?
Session time preference (please discuss with your child) -- all times EST [Be prepared for either time to be the final schedule] *
Required
Do you anticipate more than 5 weeks of tutoring this summer?
Do you anticipate tutoring beyond the summer months?
How do you prefer to pay for services? (can be changed later if needed) *
Payment preference: *
I, the parent, understand that if sessions I've paid for in advance are missed by my child for whatever reason, the session must be made up within the Summer Session window June 20-Aug 3, 2017 on a day the tutor is available or class fee will not be refunded. If the tutor cancels class, then other dates and times will be made available for a make-up session, if mutual date/time cannot be reached, then a refund of that session will be offered. *
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