Summer 2025 Registration Form

Registration Form

Please complete the following information.
Student Name:*

First NameLast Name
Student's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student's Age*
Grade that student will be entering in the fall*
School that student will be attending in the fall*
Student medical conditions (if any)*
Parent Name:*

First NameLast Name
Parent Phone Number*

Area CodePhone Number
Email*
example@example.com
Emergency Contact (other than above)*

First NameLast Name
Relationship to Child*
Emergency Contact Phone Number*

Area CodePhone Number
Services Requested (select all that apply)*

Orton-Gillingham Reading and Spelling TutoringReading Fluency/Comprehension TutoringWriting TutoringMath Tutoring
Requested format for sessions*

In Person at Literacy Learning Solutions (Nashua, NH)Remote via ZoomNo preference (either remote or in person is acceptable)
Requested Number of Sessions per Week *
Preferred Days and Times for Sessions*
The following person(s) are authorized to pick up my child from Literacy Learning Solutions (for in person sessions only)*
Any other information you would like us to know about your child?

Policies Form

Please read and sign to acknowledge consent for the following information.
Literacy Learning Solutions, LLC prides itself on providing professional, results-oriented one-to-one tutoring. In order to continue to help students succeed, we have established the following policies.

GENERAL TUTORING INFORMATION:

1. Tutoring Dates: Literacy Learning Solutions follows the New Hampshire school calendar, meaning that we are closed on major holidays and during New Hampshire school vacations. While we will remind you of center closures, it is unlikely that we will be able to offer make-up or alternative session times due to limited tutor availability.

2. Matching Students with Tutors: Every effort is made to match students with the most qualified tutor. When making assignments, we consider both the personality and needs of the student and the tutor’s teaching style and skill set. We strive to make the best match from the start, but we may decide to make changes based on the needs of the student. We welcome your feedback and will always discuss with you before making any changes.

3. Remote Learning Format: For sessions that will be conducted using Zoom videoconferencing software, tutors will send a meeting ID code and password for your child's sessions before tutoring begins. Being prepared for the sessions will help maximize the tutoring time. Prior to beginning the session, please try your best to:
- Set your child up with the appropriate technology. Computers, laptops and iPads are the best options for session participation. Accessing sessions using cell phones should be avoided since the audio/video quality is not as strong and some important features are limited.
- Have your child seated in an area that is free of noise and distractions, since background noise is easily detected through the Zoom platform. Additionally, to maximize internet connection stability, try to have your child seated near the router or another area where the signal is strongest.
- Materials that your child will need during the sessions will include a small white board or pieces of plain paper and a dark marker. Please have these ready for use. Specific tutors may have additional requests for material preparation.
- At times, there may be technical difficulties. Try to make yourself or another adult available to assist your child with troubleshooting if technical difficulties arise. If a problem should arise, here are a few tips: 1) Check video and audio settings; 2) Log out of the meeting, restart your computer, log back in to the meeting; 3) Limit other online activities on the network, hardwire into your modem, or move closer to your wireless router/access point.
4. Recordings: Although there is a recording function in the videoconferencing platform, no video/audio recording on sessions will be allowed by either party without the obtained consent of both parties.

SESSION POLICIES:

1. Session Attendance: In order for tutoring to be effective, it must occur regularly. If a student does not meet with a tutor according to the arranged schedule, it may affect the quality and effectiveness of the tutoring program. Sessions are to take place for each client on the same day and time each week. If you cancel or otherwise miss three weeks of sessions in a row, the center may no longer be able to guarantee the ongoing availability of your preferred time slot and the Center Director will contact you to determine next steps.

2. Changes in Availability: If your child has a change to his or her availability (due to extracurricular activities or otherwise) and can no longer attend his or her regularly scheduled session, please try to let us know in advance. In this case, we will make every effort to accommodate the need to change your child’s tutoring schedule but depending on availability it may require a change in tutor or the need to wait for another time slot to become available.

3. Late for Session: If you are late for an appointment, your session will need to conclude at the regularly scheduled time. If the student is more than 15 minutes late for a session, then the session will be considered missed. It is the center’s policy to charge the full session fee for all late and missed appointments.

4. Payments: Payments must be made online via our electronic payment platform. Billing will occur on a monthly basis and in advance of the sessions, with fees due on the on the 1st of each month for the upcoming month. Recurring payments will be charged automatically each month to your credit card stored on file. With card storage, you authorize Literacy Learning Solutions to charge you for agreed upon purchases and understand that your information will be saved to file for future transactions on your account. You may cancel this authorization at any time by contacting us, otherwise it will remain in effect until cancelled.

I hereby give my consent for payments in adherence with the above policy of Literacy Learning Solutions, LLC.
Initials*
5. Tutoring Fees: Fees will include all of the sessions that your child is scheduled to have in that upcoming month, not including sessions that fall on holidays or on days when Literacy Learning Solutions is closed. In the event that you wish to terminate your enrollment in tutoring before the end of the month, no refunds will be given for payments already made.

6. Additional Fees: Our tutoring sessions are typically scheduled for 60 minutes (unless otherwise agreed upon) and the associated fees cover the time that your child is working with the tutor. Time that tutors spend outside of your child’s session reviewing educational documents or other records and/or communicating with teachers or other professionals may require you to schedule a consultative appointment or pay an additional fee (at the discretion of the Center Director).

CENTER POLICIES:

1. Supervision at the Center: During in person sessions at our clinic, parents are free to wait in the waiting room or drop off and pick up their child. If you leave your child at the center, it is imperative that you return for pick up five minutes prior to the end of the tutoring session. This will ensure that the tutors can begin their next session promptly. Children ages 12 and older may leave the center if they know that a parent is waiting downstairs or outside upon written consent on this form.

2. Waiting Room: The success of tutoring sessions depends on minimal noise disruptions. Additionally, we share a building floor with other practitioners who require quiet to achieve their results. Hence, it is imperative that anyone waiting for our students observe reasonable quiet in our waiting room. We also need to be courteous to our neighbors when moving about the hallways and using the shared restrooms.

3. Photography Consent: To acknowledge students for their hard work and success in tutoring (Student of the Month) we may ask you for their photograph and display it publicly in our waiting area. By signing, you give consent for us to display your child's photograph and first name for recognition purposes only. You will always be informed and given the option to decline participation prior to photographs or names being displayed.

CANCELLATON POLICIES:

1. Cancellation of Sessions: No credits or refunds will be given for student cancellations or missed sessions, regardless of whether prior notice is given. If your child is unable to attend a regularly scheduled session, you are able to request a make up session. Make up sessions will be scheduled subject to Literacy Learning Solutions, LLC availability and may be conducted by any of our tutors. No refunds or credits will be given if you are unable to participate in a make up session.

2. Tutor Absence: If your child's tutor is absent, we will either provide a substitute teacher or determine a mutually-agreeable time to reschedule the session. If a reschedule is not possible, then we will issue you a credit for the session on your next month's invoice.

3. Inclement Weather: In the event of snow or other inclement weather, remote sessions will be conducted as usual. For in person sessions at the clinic, the Center Director will determine if it is safe for sessions to take place and will reach out to each family accordingly. In the event of an unplanned closure due to inclement weather, students will be given the option to participate remotely through Zoom, reschedule, or receive a credit on your next month's invoice.

I hereby give my consent to be charged fees in adherence with the cancellation policies (above) of Literacy Learning Solutions, LLC.
Initials*
WAIVER & RELEASE:

1. I understand that Literacy Learning Solutions, LLC will not be responsible for any injuries and/or accidents that may occur to my child/children on or around the premises of the center.

2. I understand that Literacy Learning Solutions, LLC will not be responsible for any stolen or lost items.

3. I understand that my child is expected to behave in a courteous and respectful manner towards all staff members and that Literacy Learning Solutions, LLC reserves the right to refuse service to any client for any reason.

4. I hereby release, indemnify, and hold harmless Literacy Learning Solutions, LLC and its officers, agents, and employees from any and all claims, damages, demands, costs and liabilities of any nature, including attorney’s fees and costs associated with or arising directly or indirectly from my child’s participation in any program at the center.

I have read and fully understand this agreement and I hereby voluntarily agree to and accept the terms and conditions of this agreement.
Signature*

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Registration Form

Policies Form