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Amanda ScaramozzinoLaurier Students for Literacy Co-ordinatorOffice Phone: 519-756-8228, Ext. 5819lsflbrantford@wlusu.com
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 a
nd writing skills throughliteracy activities and worksheets. This program is available to students in grades 1 to6. If you are interested in this program, registration starts on
Monday, August 31
st
,2009
and the deadline is
Monday, September 28
th
,2009
. Registration forms areavailable at the Brantford Public Library.
Child’s Information
Parent/Guardian Name: Gender:
Child’s Name:
Age:Phone Number: Grade:Home Address: Reading Level:E-mail Address:
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.
Walk with parent or guardian2.
Drive with parent or guardian3.
Bus with parent or guardian4.
Other (please specify)
Amanda ScaramozzinoLaurier Students for Literacy Co-ordinatorOffice Phone: 519-756-8228, Ext. 5819lsflbrantford@wlusu.com
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 is up todate and correct.Parents Name (please print) Signature Date
Areas for Improvement in Written Work
(Please put a check mark beside theones that pertain to your child)
:
Sentence Structure Creative Writing Summarizing MaterialsSpelling Organizing Ideas Grammar/PunctuationStory Sequencing Proofreading Vocabulary DevelopmentPhonics Journal Writing Written ResponseComments:
Areas for Improvement in Oral Reading:
Comprehension Retelling the Story Reading with ExpressionPronunciation Fluency Making ConnectionsPredictions Word Recognition DecodingInferences
Amanda ScaramozzinoLaurier Students for Literacy Co-ordinatorOffice Phone: 519-756-8228, Ext. 5819lsflbrantford@wlusu.com
Comments:
Learning Disabilities:
(Please list any learning disabilities below)
Availability:
Please indicate the times that work best for you and your family by numbering yourchoices from 1-5, 1 being your top choice.
Time Monday Tuesday Wednesday Thursday4:005:006:007:00
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 28
th
,2009.
Please drop off the forms at the Brantford Public Library. If you have anyquestions or concerns please feel free to contact Amanda Scaramozzino LSFL Co-ordinator or Sue Matthews Book Buddy Executive at 519-756-8228, ext. 5819 or e-mail us at lsflbrantford@wlusu.com.
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