After3 - Remedial Math Registration
Parent Contact Information
Parent First Name: *
Parent Last Name: *
Address (including postal code): *
Phone Number: *
Email: *
Alternate Parent/Guardian/Caregiver - Name, Relationship, and Number: *
Emergency Contact - Name, Relationship, and Number (include cell and work number when relevant): *
How did you hear about this service?
Student Information
Child First Name: *
Child Last Name: *
Current Grade *
Current School *
Student Profile
What are the reasons for wishing the applicant to enroll in After3 Remedial Math? *
Describe the applicant's academic areas of difficulty with mathematics? (eg. number sense, word problems, numeracy) *
Has the applicant received remedial instruction, such as learning assistance or tutoring, either at, or outside of his or her current school? If yes, please provide details. *
Has your child attended or applied to Fraser Academy before? *
Please select the boxes that apply as to the information you can provide us for creating your child's program: *
Please submit copies of these documents electronically to FAx or hard copies to the school (2294 West 10th Ave) as soon as possible.
Required
Instructional Options
We want our lessons to be: *
Desired Start Date *
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Admissions Request *
Days for Service (please select two)
Preferred Time *
Required
Medical Information
Student's Date of Birth: *
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Please indicate any medical information or allergies (if this does not apply, please type "N/A"): *
Parent/Guardian Consent:
*
Required
Payment
Please select one of the four payment options.
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Confirmation
I understand that the fee for After3 Programs at Fraser Academy is non-refundable, and that there will be two make-up sessions per semester for any lessons missed , to be coordinated by your instructor with the student. *
Required
Signature (type Parent/Guardian Name): *
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