Lsfl - Book Buddy Registration Form 09-10

Amanda Scaramozzino Laurier Students for Literacy Co-ordinator Office Phone: 519-756-8228, Ext. 5819 [email protected]

LSFL Book Buddy Registration Form The Book Buddy program is a free program run by Laurier Student’s for Literacy. We offer one-on-one tutoring for 45 minutes a week. All the volunteers are eager to support and build confidence in your child’s reading and writing skills through literacy activities and worksheets. This program is available to students in grades 1 to 6. If you are interested in this program, registration starts on Monday, August 31st, 2009 and the deadline is Monday, September 28th,2009. Registration forms are available at the Brantford Public Library.

Child’s Information Parent/Guardian Name: Child’s Name: Phone Number: Home Address: E-mail Address:

Gender: Age: Grade: Reading Level:

Emergency Contact: We will contact this person only in the event of an emergency, or if the child’s parent/guardian is not available. Name of Emergency Contact Person: Relation to Child: Phone Number:

How will your child get to and from the library each week? 1. 2. 3. 4.

Walk with parent or guardian Drive with parent or guardian Bus with parent or guardian Other (please specify)

Amanda Scaramozzino Laurier Students for Literacy Co-ordinator Office Phone: 519-756-8228, Ext. 5819 [email protected]

Medical Information Please list any allergies and/or medical information (ex. Diabetes, hearing problems, vision impairment, peanut allergy, etc.) and medicine or intervention required.

I authorize that the above information about date and correct.

Parents Name (please print)

is up to

Signature

Date

Areas for Improvement in Written Work (Please put a check mark beside the ones that pertain to your child): Sentence Structure Spelling Story Sequencing Phonics

Creative Writing Organizing Ideas Proofreading Journal Writing

Summarizing Materials Grammar/Punctuation Vocabulary Development Written Response

Comments:

Areas for Improvement in Oral Reading: Comprehension Pronunciation Predictions Inferences

Retelling the Story Fluency Word Recognition

Reading with Expression Making Connections Decoding

Amanda Scaramozzino Laurier Students for Literacy Co-ordinator Office Phone: 519-756-8228, Ext. 5819 [email protected]

Comments:

Learning Disabilities: (Please list any learning disabilities below)

Availability: Please indicate the times that work best for you and your family by numbering your choices from 1-5, 1 being your top choice. Time 4:00 5:00 6:00 7:00

Monday

Tuesday

Wednesday

Thursday

Thank you! You can expect to be contacted by your child’s buddy within the next few weeks! Reminder: The deadline for the Book Buddy Sign-Up is Monday, September 28th, 2009. Please drop off the forms at the Brantford Public Library. If you have any questions or concerns please feel free to contact Amanda Scaramozzino LSFL Coordinator or Sue Matthews Book Buddy Executive at 519-756-8228, ext. 5819 or email us at [email protected].

Amanda Scaramozzino Laurier Students for Literacy Co-ordinator Office Phone: 519-756-8228, Ext. 5819 [email protected]

Laurier Students for Literacy (LSFL) Book Buddy Program Photograph Permission Form Dear Parents/Guardians: As you know, your child is participating weekly in the Laurier Students for Literacy Book Buddy program at the Brantford Public Library. We are very excited that you child is participating with us and we hope you find the program beneficial. Later this year, we are hoping to take a few photographs of our volunteers “in action” while they read with the students in the Book Buddy program at the library. We are requesting your permission to include your son/daughter in a few of these photographs. These photos will be used only for promotional purposes and materials, as on posters and brochures. They may also be posted on the Laurier Students for Literacy website in a photo album. Your child’s name will not appear on any materials, in accordance with the Laurier Students for Literacy Confidentiality Agreement. Please complete the following information and return to your child’s Book Buddy. Thank you,

Amanda Scaramozzino, Laurier Students for Literacy Co-ordinator

____________________________________________ YES, I give permission for to be photographed with his/her Book Buddy for Laurier Students for Literacy promotional materials. I understand that my child’s identity (eg. name) will not be shared in any matter. Name:

Signature:

Date:

NO, I do not give permission for to be photographed with his/her Book Buddy for Laurier Students for Literacy promotional materials.