Tutoring, Homework & English Support: United Way School's Out (2023-24 Registration Form)
 
STUDENT REGISTRATION FORM
Tutoring, Homework and English 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, in room 401). A child can participate in either the Monday OR Thursday sessions (not both).

The upcoming iteration will run from the week of May 6th to June 17th, 2024. Sessions are from 4:00 pm to 5:30pm.

This 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 .     My child:
Has never participated in this program before.  
Has participated in 3 or fewer weeks of this program in the past.  
Has participated in 4 or more weeks of this program in the past.  
Q3 .     Child's first name
*
Q4 .     Child's last name
*
Q5 .     Child's birthdate
month/day/year : *
Q6 .     Child's gender
*
Q7 .     Home Address (number, street, city, province and postal code)
*
Q8 .     Parent/ guardian first name
*
Q9 .     Parent/ guardian last name
*
Q10 .     Parent/ guardian phone number (cell or home)
*
Q11 .     Parent/ guardian email
*
Q12 .     What is the family’s country of origin?
*
Q13 .     What is the language spoken at home?
*
Q14 .     What is the child's first language?
*
Q15 .     How long has the family been living in Canada?
*
Q16 .     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?
*
Q17 .     Name of child's school
*
Q18 .     Child's grade
*
Q19 .     What are the child’s best school subjects(s)?
*
Q20 .     What are the child’s more difficult school subject(s)?
*
Q21 .     Emergency contact Name (First and Last Name)
*
Q22 .     Emergency contact relationship to child
*
Q23 .     Emergency contact phone number (cell or home)
*
Q24 .     Emergency contact email
*
Q25 .     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:  
Q26 .     Person 1 (who can pick my child up)
Name :
Relationship to child :
Q27 .     Person 2 (who can pick my child up)
Name :
Relationship to child :
Q28 .     Person 3 (who can pick my child up)
Name :
Relationship to child :
Q29 .     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  
Q30 .     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 my child is sick I will notify you in advance)
Yes  
No  

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