Tutoring, English & Homework Support Registration (In-Person)
 
STUDENT REGISTRATION FORM
Tutoring, English & Homework Support is a free after-school program for Surrey children in grades 4 to 7. The program is offered on Mondays and Thursdays (in-person at the Central City Library). The first iteration goes from October 3, 2022 to February 16, 2023. Sessions are from 4:00 pm to 5:30pm. PLEASE NOTE: Students will be registered in the program on a first-come, first-serve basis. We will accept 25 registrations for each day. If the program is full, students will be placed on a waitlist and contacted if a spot becomes available. The program is for children who are newcomers to Canada or whose parents are newcomers to Canada.

PLEASE NOTE: As of Oct 13, 2022, this program is FULL and new registrants will be waitlisted until spots open up.

Q1 .     Child's first name
*
Q2 .     Child's last name
*
Q3 .     Child's gender
*
Q4 .     Child's grade
*
Q5 .     Name of child's school
*
Q6 .     What is the child's first language?
*
Q7 .     What is the language spoken at home?
*
Q8 .     I want to register my child for the following Tutoring cohort. (Please note that if all the cohort spots are filled, your child will be added to the waitlist)
*
Q9 .     Home Address (number, street, city, province and postal code)
*
Q10 .     Parent/ guardian first name
*
Q11 .     Parent/ guardian last name
*
Q12 .     Parent/ guardian phone number (cell or home)
*
Q13 .     Parent/ guardian email
*
Q14 .     Emergency contact's name (First and Last Name)
*
Q15 .     Emergency contact's phone number (cell or home)
*
Q16 .     Emergency contact's relationship to child
*
Q17 .     I understand that my child must be present for all the sessions and bring their homework or another item to work on with the tutors (if child is sick please notify us in advance)
Yes  
No  
Q18 .     USE OF PERSONAL INFORMATION FOR PROGRAM REGISTRATION I consent to having the information on this form used for the purposes of registering my child in the Tutoring, Homework, and English Support program. I understand that the information on this form is collected under the general authority of the University Act (R.S.B.C. 1979, c.419). It is related directly to and needed by the University for registration to the TUTORING program. The information will be used to determine eligibility for the program, to track program registrants, to ensure the health and safety of students, to provide the best service to students as possible, and to track/report out on the success of the program. If I have any questions about the collection and use of this information, I know that I can contact the Associate Director, Partnerships and Programs: 13450 102 Avenue, Surrey BC, V3C 6M8; 778-782-8082
Yes  
No  
Q19 .     PROGRAM EXPECTATIONS AND ASSUMPTION OF RISK. I consent to and am aware of the following while participating in programs offered through the SFU Surrey – TD Community Engagement Centre: 1. I understand that the program is meant to provide learning and social development opportunities, but is not a formal educational program. Program facilitators / leaders are not professional teachers or educators. 2. I understand that this program is a weekly commitment and I will support my child’s participation for the duration of the program. 3. My child will respect the staff/volunteers and other students participating in the program. Failure to act appropriately may result in the loss of the privilege of attending the program. 4. I understand that the program may collect information from students or teachers for basic evaluation purposes to ensure continuous improvement of the program. 5. I hereby release, indemnify and hold harmless Simon Fraser University and any other organizations involved in program delivery, their officers, officials, agents and/or employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the program, from any and all claims, demands, losses, and liability arising out of or related to any injury, or loss or damage to person or property, to the fullest extent permitted by law.
Yes  
No  


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