Homework Buddy
Reading Helper
Student's Name
First Name
Last Name
Parent's Phone Number
*
Include a valid number
Format: (000) 000-0000.
Parent's Email
example@example.com
Emergency/ Alternate Pick up Person
First Name
Last Name
Emergency Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Grade
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
Does your child have a learning disability?
Specific skills your child need to improve on
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