Registration for Golden Tutoring’s Spring 2017 Literacy Launch™ Workshop
for 1st & 2nd Graders

Wednesdays from 2:55-4:00 pm

April 12, 19, and 26; May 3, 10, 17

Mitchell Elementary

$100/student

Parent Information
1st Parent Name*
First Last
1st Parent Phone Number*
1st Parent Phone Type*
1st Parent Alternate Phone Number
1st Parent Alternate Phone Type
1st Parent Email*
1st Parent Address*
Street Address City State ZIP Code
2nd Parent Name
First Last
2nd Parent Phone Number
2nd Parent Phone Type
2nd Parent Alternate Phone Number
2nd Parent Alternate Phone Type
2nd Parent Email
Does the 2nd parent have the same mailing address?
- Yes
- No
2nd Parent Address
Street Address City State ZIP Code
Additional Parent/Guardian Information (Optional)
Student Information
Student Name*
First Last
Student Birthdate (optional)
MM
DD
YYYY
Student Grade*
Student's Teacher:*
Student Additional Information/Health Concerns
Please describe any other information (such as medical needs, dietary restrictions) we should know about this student.
Student Will Be Picked Up By:*
If this student will be picked up by someone other than the parents listed above, please also provide a phone number
Other Important Information
How did you hear about Golden Tutoring's Literacy Launch Workshops (check all that apply)*
- Website
- Word of mouth
- PTA newsletter
- Flyers
- Other
Other ways that you heard about Golden Tutoring's Literacy Launch Workshops
Parent Permission*
By selecting "I GIVE PERMISSION" above, and typing your name and date below, you give permission for your child(ren) to participate in workshops offered by Golden Tutoring and Enrichment, LLC. You understand that appropriate safety precautions will be used during workshops. You also understand that you voluntarily are allowing your child(ren) to participate in the workshop(s) and expressly assume all risks and dangers of the workshop(s), whether or not described above, known or unknown, inherent or otherwise. You also understand that you are responsible for the prompt pickup of your child(ren). You also understand that there are no refunds after March 29th, 2017
Parent/Guardian Signature*
Please type your name above
Today's Date*
MM
DD
YYYY
Payment Information
Note that registration is not guaranteed until we receive payment. We will email a confirmation of your registration.
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Spring 2017 Literacy Launch Registration

Spring 2017 Literacy Launch Registration

Registration for Golden Tutoring’s Spring 2017 Literacy Launch™ Workshop for 1st & 2nd Graders

Parent Information

Student Information

Other Important Information

Payment Information

Registration for Golden Tutoring’s Spring 2017 Literacy Launch™ Workshop
for 1st & 2nd Graders