Dr. Clark’s Reading Centre Summer Registration Form 2020
Student's name: *
Parent/Guardian name(s): *
Cell phone:
Home phone:
Business phone:
E-mail address: *
Desired program(s): *
Required
Desired number of sessions/week: *
Desired tutor:
16-Session Monday/Wednesday Program (Mon. Jun. 29 - Wed. Aug. 19):
Select desired start time by specifying your preference from 1st to 6th choice. If you are flexible and can do either the Monday/Wednesday program or Tuesday/Thursday program, please fill out preference from 1 to 6 for both. This will likely result in you being offered a more preferred tutoring time. If you are interested in only one session per week, bypass the 16-session selection charts and go directly to the '8-Session Program' chart.
8:30am
9:15am
10:00am
10:45am
11:30am
12:15pm
1:00pm
1:45pm
2:30pm
3:15pm
4:00pm
4:45pm
5:30pm
6:15pm
7:00pm
1st choice
2nd choice
3rd choice
4th choice
5th choice
6th choice
Clear selection
16-Session Tuesday/Thursday Program (Tues. Jun. 30 - Thur. Aug. 20):
Select desired start time by specifying your preference from 1st to 6th choice. If you are flexible and can do either the Monday/Wednesday program or Tuesday/Thursday program, please fill out preference from 1 to 6 for both. This will likely result in you being offered a more preferred tutoring time. If you are interested in only one session per week, bypass the 16-session selection charts and go directly to the '8-Session Program' chart.
8:30am
9:15am
10:00am
10:45am
11:30am
12:15pm
1:00pm
1:45pm
2:30pm
3:15pm
4:00pm
4:45pm
5:30pm
6:15pm
7:00pm
1st choice
2nd choice
3rd choice
4th choice
5th choice
6th choice
Clear selection
8-Session Program (one session/week - Mon. Jun. 29 to Thur. Aug. 20):
Select all of the days/times that will work for you.
8:30am
9:15am
10:00am
10:45am
11:30am
12:15pm
1:00pm
1:45pm
2:30pm
3:15pm
4:00pm
4:45pm
5:30pm
6:15pm
7:00pm
Monday
Tuesday
Wednesday
Thursday
Declaration of absence (a maximum of 4 can be rescheduled for the 16-session program and a maximum of 2 for the 8-session program):
MM
/
DD
/
YYYY
Declaration of absence (2nd):
MM
/
DD
/
YYYY
Declaration of absence (3rd):
MM
/
DD
/
YYYY
Declaration of absence (4th):
MM
/
DD
/
YYYY
Please list any additional absences:
After the conclusion of the summer program, should you continue with fall tutoring what tutoring format would you prefer? *
Additional comments:
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