Handwriting Tutoring Registration Form- Fall 2025

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6-Week session: Wednesdays from 4:30-5:30pm

Children entering grades 1-5

Thank you for completing this registration form. A completed registration form and $50 deposit are required to secure your student's spot. Your deposit will be applied to the class total ($270 per student).

Please call the office to pay your student's deposit . Ph: (407) 277-5400

We look forward to working with your student and your family!

Email *

Record my email address with my response

Child's Name:

Child's Birthdate: *

Child's Age: *

Current Grade Level: *

Current School: *

Allergies: (please list) *

Current Medications: (please list) *

Any special considerations, activity restrictions or other health concerns you would like us to be aware of? *

Parent/Guardian Name: *

Parent/Guardian Phone: *

Parent/Guardian Address: (street, city, zip code) *

Does your child attend a Regular Education classroom: *

Yes

Does your child receive any accomodations at school: *

504 Plan (classroom accomodations)

IEP (Individualized Education Plan)

School-based therapy- OT, PT, ST or Behavior Therapy - YES

Pull out instruction for specific subjects

None of the above

Required

Please mark the skills your child can perform independently: *

Holds pencil with fingers

Colors a simple picture inside of the lines

Cuts on a line with scissors

Able to name/identify all letters of their name

Able to name/identify all letters of the alphabet

Able to write first name

Able to write last name

Able to copy uppercase alphabet

Able to copy lowercase alphabet

Able to write single words

Able to write sentences

Able to write paragraphs

Required

How can Handwriting Tutoring best help and support your child? *

Are there any handwriting concerns your child's teacher has shared? (please explain) *

Can you provide a work sample and/or bring your child's notebook to the first class? *

Yes

Cost: 6-Week Tutoring session ($270 per student).

A $50 Deposit is required to hold your students spot and will be deducted from the class total.

$50 deposit paid?

Yes

How did you hear about Handwriting Tutoring? *

Google

Social Media (Facebook, Instagram, LinkedIn)

Website

Word of mouth

Other:

Required

Send me a copy of my responses.

Submit

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