Youth Registration Form | 2020-2021 School Year | Grades K-12


UNTIL 2021, ALL CLASSES WILL BE ONLINE
Student Information
Student Name: *
Date of Birth: *
Place of Birth:
Gender:
Clear selection
Student's First Language:
Clear selection
Current School:
Grade: *
Required
Classroom Teacher's Name:
Tutoring Needed In: *
Required
Is this a new or returning student?
Clear selection
Household Information
Parent/Guardian Name: *
Address: *
Phone Number *
Email Address:
Do you have access to a computer?
Clear selection
Do you have access to the internet?
Clear selection
Availability
9 - 10am
10-11am
1-2 pm
2-3 pm
3-4 pm
4-5 pm
Monday
Tuesday
Wednesday
Thursday
Friday
I give my permission for the above student to be photographed or recorded for purposes of distance learning activities and for their voice and image to be transmitted and viewed by instructors involved in distance learning activities at Good Counsel Learning Center. *
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