Student Application

Emergency Contact Information
Does your child/children have any serious health concerns that we should be aware of for our sessions?*

YesNo
In the unlikely event of an emergency situation occurring during our session, who should we use as the emergency contact?*

Parent/Contact 1Parent/Contact 2Other
Emergency Contact Name*

First NameLast Name
Relationship to the Student*
Please specify relationship.*
Phone Number*
Please describe your child's health condition and the best way for us to respond in case of an emergency:*

Student's Educational Background
Student's Educational Background

Please fill this out for the first child listed on page 1
Student's Name*

First NameLast Name
How many school years has your child been enrolled in homeschooling?*
How many other children are also educated in the same home/learning facility?*
Please describe your child's learning strengths, especially with regards to reading/writing:*
Please describe your child's learning weaknesses, especially with regards to reading/writing:*
Has your child been diagnosed with any learning disabilities that would be important for us to be aware of. If so, please also note any accommodations he or she may benefit from during our sessions. *
*We cannot guarantee that suggested accommodations will be implemented but will do our best to accommodate learning needs wherever possible.
What days/times is your child unavailable due to co-ops or other live learning sessions?*
*Please note that we operate in Eastern Standard Time
What time of day would you prefer your child's guided reading session to be scheduled?*
*Please note that we operate in Eastern Standard Time. We cannot guarantee that preferred times will be assigned.

Student's Educational Background

Please fill this out for the second child listed on page 1
Student's Name*

First NameLast Name
How many school years has your child been enrolled in homeschooling?*
Please describe your child's learning strengths, especially with regards to reading/writing:*
Please describe your child's learning weaknesses, especially with regards to reading/writing:*
Has your child been diagnosed with any learning disabilities that would be important for us to be aware of. If so, please also note any accommodations he or she may benefit from during our sessions. *
*We cannot guarantee that suggested accommodations will be implemented but will do our best to accommodate learning needs wherever possible.
What days/times is your child unavailable due to co-ops or other live learning sessions?
What time of day would you prefer your child's guided reading session to be scheduled?*
We cannot guarantee that preferred times will be assigned.

Student's Educational Background

Please fill this out for the third child listed on page 1
Student's Name

First NameLast Name
How many school years has your child been enrolled in homeschooling?*
Please describe your child's learning strengths, especially with regards to reading/writing:*
Please describe your child's learning weaknesses, especially with regards to reading/writing:*
Has your child been diagnosed with any learning disabilities that would be important for us to be aware of. If so, please also note any accommodations he or she may benefit from during our sessions. *
*We cannot guarantee that suggested accommodations will be implemented but will do our best to accommodate learning needs wherever possible.
What days/times is your child unavailable due to co-ops or other live learning sessions?*
What time of day would you prefer your child's guided reading session to be scheduled?*
We cannot guarantee that preferred times will be assigned.

2021-2022 School Year Financial Information

Rates:

10-Week Fall Semester ---$500 per student
Early Enrollment 10% Discount Sale--$450 per student

Family Discounts:

Second Child--20% Off

Third Child & any more additional children---30% Off

Payments are due on Monday before the start of new semester.

Forms of payment:

Credit Card
Paypal

Accounts with payments more than 1 week late will be closed.(Student will be withdrawn from the program unitl payment is made and depending on availabilty).
Which enrollment type are you applying for?*
How many children are you enrolling today?*
Signature
I affirm that the information provided is true, correct and complete, to the best of my knowledge and belief. This electronic signature below and its related fields are treated by The Little Way Readers like a handwritten signature on a paper form,*

Yes
Your Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Today's Date*
mm/dd/yyyy
Please enter the preferred email address at which to receive emails from The Little Way Readers.*
example@example.com
Please make sure to read through all of our terms & conditions as well as our various policies before agreeing. These terms layout parent/guardian and student expectations as well as our payment, refund, and privacy policies.
Please select the number of children you are submitting a deposit for today:*
prevnext( X )
Fall Semester Deposit$ Free
Please submit a nonrefundable $50 deposit to reserve your child's spot in our spring semester. This deposit will be applied to your final payment.

Quantity

Total $0.00
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10-Week Fall Semester Enrollment Form

Student Information

Family Information

Parent/Contact 1

Parent/Contact 2

Emergency Contact Information

Student's Educational Background

Student's Educational Background

Student's Educational Background

Student's Educational Background

Signature