Registration – Literacy Lift Off

Literacy Lift Off Registration

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Student Name

First

Last

Student Age

Grade Level *

Parent/Guardian Name

First

Last

Parent/Guardian Email

Email to Parent/Guardian

Parent/Guardian Phone Number *

Tutoring Subjects Needed

If other, please describe

Preferred Tutoring Format

Availability (days/times)

Desired Start Date

Goals / areas to focus on

Any learning accommodations or relevant notes

Do you agree to be contacted about tutoring services?

Preferred method of contact (email/phone/text) and best time to reach you

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