Care & Connect Sign Up Form / Referral
Welcome to Eliot's Care & Connect! Care & Connect is a time for students to be able to connect one on one with a staff member who can help then with academics or tech support or simply socialization time. We offer in person or Zoom options.
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Who are you?
Name:
Student's name, grade, teacher
Phone Number:
Email Address:
Preferred method of contact
Would you like to meet in person or via Zoom
Clear selection
Type of Care and Connect Needed: (This is Confidential)
Which day (days) of the week would you like for your child to attend Care & Connect? You may select more than one.
Would you like your child to attend every week at the same time or one time only.
Clear selection
Please Select a Time Preference:
Submit
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