This form needs to be completed EVERY WEEK at least 1 day prior to the tutoring session your child will attend. Students must be picked up in the front of the school no later than 4:15 pm. Tutoring sign-up for the week of 5/15-5/18.

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Student's First Name *

Student's Last Name *

Grade Level *

MATH TUTORING- Meet in Room 202. My child will attend math tutoring this week on the following dates/times:

Wednesday 3:15pm-4:15pm

ENGLISH TUTORING- Meet in Room 93. My child will attend tutoring this week on the following dates/times:

Wednesday 3:15pm-4:15pm

SOCIAL STUDIES/GENERAL TUTORING- Meet in Room 254. My child will attend tutoring this week on the following dates/times:

Monday 3:15pm-4:15pm

Thursday 3:15pm-4:15pm

My student will be a: *

CAR RIDER; My child will be picked up at the front of the school no later than 4:15 pm. Students will no longer be able to attend after two late pickups.

WALKER; my child has permission to walk home

Emergency Contact Name *

Emergency Contact Number *

By checking the box below, I understand that my child must be picked up no later than 4:15 pm. Two late pick-ups will result in dismissal from after-school tutoring for the semester. *

My child must be picked up no later than 4:15 pm. Two late pick-ups will result in dismissal from the tutoring program.

Required

By checking the box below, I understand that after-school tutoring is optional, and my child will be dismissed if he/she does not follow school rules/procedures. *

My child will follow school rules/procedures during after-school tutoring. I understand that my child will be dismissed for the semester if he/she does not follow all school rules/procedures.

Required

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