Reading and Math Blast - ENROLLMENT FORM

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This Targeted Services program is FREE for students who qualify and/or are recommended by your child's teacher (typically for students performing at or below the 40th percentile in reading and/or math).

MARK YOUR CALENDAR with the following dates for Reading and Math Blast:
Tuesdays and Thursdays (from 3:00-4:15):
Oct. 27, Oct. 29, Nov. 3, Nov. 5, Nov. 10, Nov. 12
Nov. 17, Nov. 19, Dec. 1, Dec. 3, Dec. 8, Dec. 10
Jan. 12, Jan. 14, Jan. 19, Jan. 21, Jan. 26, Jan. 28
Feb. 2, Feb. 4, Feb. 23, Feb. 25, March 1, March 3
March 8, March 10, March 15, March 17, March 22, March 24
March 29, March 31, April 12, April 14, April 19, April 21

My child's teacher recommended my child for Reading and Math Blast. *

This is a requirement in order to enroll in these FREE classes. This may have been recommended at a conference or in some other way - your child's teacher recommended that extra opportunities would benefit your child (typically for students performing at or below the 40th percentile in reading and/or math).

Yes - if so, continue enrolling your child

No - if not, please stop the enrollment process and talk with your child's teacher

I don't know - If you don't know for sure, please stop the enrollment process and talk with your child's teacher

Child's Student Number *

Your child knows this number if you don't (it is how they log-in to a computer at school). It likely starts with 903 or 640 and is likely 8-digits in length.

Student's FIRST and LAST NAME *

Current GRADE *

Transportation Needs *

When the class is over, what do you want your child to do?

My child needs a bus.

I will provide transportation (or my child will walk).

My child will attend the YMCA.

Other:

Required

Student's Current Teacher *

Butler

Goetz

Hultgren

Huss

Peters

Tate

Student Participation Expectations...visit the link below *

SIGN YOUR NAME HERE - This means that you have read and understand this policy. Found at: http://bit.ly/TSAgreement

Snack Policy...visit the link below *

SIGN YOUR NAME HERE - This means that you have read and understand this policy found at: http://bit.ly/FHafterschoolsnacks

After School Academy Criteria *

SIGN YOUR NAME HERE to indicate that you've read the link about how students qualify for support through this program. Visit: http://bit.ly/afterschoolcriteria

Student FIRST and LAST NAME *

STUDENT SIGNS HERE - This is verification that your child is aware of and agrees to all of the above as well.

Parent/Guardian FIRST and LAST NAME *

SIGN YOUR NAME HERE - This serves as your signature to grant permission for your child to attend

Parent/Guardian EMAIL ADDRESS *

This address is used for sending a confirmation of enrollment notice.

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