Tutoring, English & Homework Support (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 upcoming iteration goes from February 23 to June 15, 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.
Q1 .     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)
*
Q2 .     Child's first name
*
Q3 .     Child's last name
*
Q4 .     Child's birthdate
month/day/year : *
Q5 .     Child's gender
*
Q6 .     Home Address (number, street, city, province and postal code)
*
Q7 .     Parent/ guardian first name
*
Q8 .     Parent/ guardian last name
*
Q9 .     Parent/ guardian phone number (cell or home)
*
Q10 .     Parent/ guardian email
*
Q11 .     What is the family’s country of origin?
*
Q12 .     What is the language spoken at home?
*
Q13 .     What is the child's first language?
*
Q14 .     How long has the family been living in Canada?
*
Q15 .     Does the child have any medical conditions (e.g. allergies, dietary restrictions, behavioural/developmental conditions) or other health related matters which staff should be aware of?
*
Q16 .     Name of child's school
*
Q17 .     Child's grade
*
Q18 .     What are the child’s best school subjects(s)?
*
Q19 .     What are the child’s more difficult school subject(s)?
*
Q20 .     Emergency contact Name (First and Last Name)
*
Q21 .     Emergency contact relationship to child
*
Q22 .     Emergency contact phone number (cell or home)
*
Q23 .     Emergency contact email
*
Q24 .     Dismissal Information (please check one):
My child has permission to walk home alone.  
My child will be picked up after each session by the following designated people:  
Q25 .     Person 1 (who can pick my child up)
Name :
Relationship to child :
Q26 .     Person 2 (who can pick my child up)
Name :
Relationship to child :
Q27 .     Person 3 (who can pick my child up)
Name :
Relationship to child :
Q28 .     How did you hear about the Friends of Simon Tutoring Program?
Website  
Post-card  
Friend referral  
SFU staff referral  
City Centre Library referral  
Elementary or high school staff referral  
Other organization referral  
Other  
Q29 .     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  

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