Book Buddies: Buddy Sign-Up Form

Book Buddies: Buddy Sign-Up Form

Please submit by Monday, June 15th

 

 

  1. Name:___________________________________

  2. Grade entering in the fall:_______

  3. Which session will you be attending?

      ___Mondays at Pemberville, 9-10:30 AM (June 22-July 27)

      ___Mondays at Pemberville, 10:30 AM -12:00 PM (June 22-July 27)

      ___Mondays at Pemberville, 12:30-2:00 PM (June 22-July 27)

     ___Tuesdays at Pemberville, 11:30 AM-1:00 PM (June 23-July 28)

     ___Tuesdays at Pemberville, 1:00-2:30 PM (June 23-July 28)

     ___Thursdays at Luckey, 2:00-3:30 PM (June 25-July 30)

     ___Thursdays at Luckey, 3:30-5:00  PM (June 25-July 30)

     ___Thursdays at Luckey, 5:00-6:30 PM  (June 25-July 30)

 

  1.  Are there any days you will not be able to attend?

         ____________________________________________________________________________________________________

     Are there any other sessions you would be able to attend if needed to ensure an equal number of buddies and tutors at each session?

     _________________________________________________________________________________________________

 

     _________________________________________________________________________________________________

 

     _______________________________________________________________________________________________

  1. Phone Number:_____________________________

  2. Email Address:______________________________

  3. What is the best way to contact you?______________________________________

  4. Would you like to receive reminders? ________email   ____text   ______no reminders

  5. Does your child have any allergies or health issues that I should be aware of?

_______________________________________________________

  1. Who should be contacted in case of emergency?

    1. Name:______________________________________Phone:_______________________

    2. Name:______________________________________Phone:_______________________

     

 

 

I give___________________________________permission to participate in the Book Buddies program.

Parent/Guardian Signature:_______________________________________________ Date:_________