Dr. Clark’s Reading Centre Registration Form 2020-21
Student's name: *
Student's grade: *
Student's date of birth: *
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/
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Parent/Guardian name(s): *
E-mail address: *
Cell phone:
Home phone:
Business phone:
Desired program(s): *
Required
Desired number of session/week: *
Desired tutor:
Select all of the days/times that will work for you, both on weekdays and weekends
Desired weekday start time:
1:45pm
2:30pm
3:15pm
4:00pm
4:45pm
5:30pm
6:15pm
7:00pm
7:45pm
Monday
Tuesday
Wednesday
Thursday
Friday
Desired weekend start time:
10:00am
10:45am
11:30am
12:15pm
1:00pm
1:45pm
2:30pm
3:15pm
4:00pm
4:45pm
5:30pm
Saturday
Sunday
Which one-to-one tutoring format would you prefer? *
Additional comments:
Submit
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