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Waitlist Survey
Thank you for your interest in support for your child. Kindly complete this survey to be added to our waitlist.
* Indicates required question
Email
*
Your email
Family Name
*
Your answer
Your Child's First Name
Your answer
Your Child's Date of Birth
MM
/
DD
/
YYYY
Your Child's Current Grade
Your answer
Parent/Guardian First Name
Your answer
Parent/Guardian Last Name
Your answer
Address
Your answer
Phone Number
Your answer
What type of support are you looking for?
*In-Person* Structured LIteracy Support (offered only on Bowen Island)
*Online/Virtual* Structured Literacy Support
Executive Function Coaching
Writing Skills Support
Parent Support/Coaching
Clear selection
Please briefly describe the reason for your request for support and any challenges your child is having.
Your answer
Has your child received any assessments inside or outside of school?
Yes
No
Clear selection
If you answered 'yes' to the previous question, please briefly describe the results of their assessment.
Your answer
Please indicate your availability for lesson times.
Weekdays during school hours (between 8am and 2pm)
After school (between 2:20pm and 6:00pm)
Clear selection
Send me a copy of my responses.
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