Book Buddies: Tutor 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)

4.  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?

     _________________________________________________________________________________________________

     _________________________________________________________________________________________________

     _______________________________________________________________________________________________

5. Phone Number:_____________________________

6. Email Address:______________________________

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

8. Have you been a Book Buddies tutor in the past?

        Yes    No

9. If you have not attended a tutor-training meeting in the past, please plan to attend one of the following informational meetings.        *Please note: Attending one of these meetings is required for all new tutors.

  __ Thursday, June 18 at 2 PM (Luckey Branch Library)

                 __ Saturday, June 20 at 10 AM (Pemberville Public Library)

10.  Do you have any allergies or health issues that I should be aware of?

_______________________________________________________

11. Who should be contacted in case of emergency?

    1. Name:______________________________________Phone:_______________________

    2. Name:______________________________________Phone:_______________________

12. Would you like to receive reminders? ______email     _____text  _____no reminders

I give___________________________________permission to participate in the Book Buddies program.

Parent/Guardian Signature:_______________________________________________ Date:_________