LBN Buddy Registration Form (Summer 2025, Fall 2025, Winter/Spring 2026)

LBN Buddy Registration Form

Summer 2025, Fall 2025, and Winter/Spring 2026
Welcome to our online registration portal!

Please complete the following pages to submit a registration application for the Summer 2025-Winter/Spring 2026 terms.

All programs are reserved for children performing below grade level. Math programs are for children in Grades 3 - 5. Reading programs are for children in Grades 1 - 5. Grade 6 and 7 students performing below Grade expectations are accepted on a case-by-case basis. Grade 1 students are not accepted until January of their Grade 1 school year.

Bella Bella Community School: If your family is part of our Bella Bella Community School partnership in Bella Bella, BC, please reach out to Trina at BBCS directly for a Buddy Registration Form, or email us at: registration@learningbuddiesnetwork.com.
1. Inform your child's teacher of interest in Learning Buddies Network's (LBN) programs and discuss with them if either math or reading support would be most beneficial.
2. Include your child's teacher and teacher email on the registration form to send them a direct link to the Buddy Referral Form
3. If you are not able to provide this information on the registration form, share the link to the Buddy Referral Form with your child's teacher: https://form.jotform.com/251217280664253
Up-to-date Buddy Referral forms filled out by a child's teacher are required for all students; if your child is a returning buddy that had a referral submitted for Summer 2025 to Winter/Spring 2026, a teacher referral form may not be required. Special exceptions may be made.
If you have any registration questions, please email registration@learningbuddiesnetwork.com.

If you experience any technical difficulties or require technical assistance, please email systems@learningbuddiesnetwork.com.

We'd love to help!

Child Information
Child's Name*

Buddy First Name (Legal)Buddy First Name (Preferred)Buddy Last Name
Age (as of September 1st, 2025)*
Number
Grade (as of September 1st, 2025)*
Number
Date of Birth*

MonthDayYear
Date

Parent/Guardian Information
First Parent or Guardian
First Parent or Guardian Name*

TitleFirst Name (Legal)Preferred First Name (if different from legal name)Last Name (Legal)
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Email Address (for all LBN communications)*

Confirmation Emailexample@example.com
Second Parent or Guardian (If Applicable)
Second Parent or Guardian Name

TitleFirst Name (Legal)Preferred First Name (if different from legal name)Last Name (Legal)
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Email Address (for all LBN communications)

Confirmation Emailexample@example.com

Child's Emergency Contact
Please note: Your child's emergency contact should be someone other than the parent(s)/guardian(s) listed previously.
Emergency Contact Name*

TitleFirst Name (Legal)Preferred First Name (if different from legal name)Last Name (Legal)
Emergency Contact (Relationship)*
E.g. Grandparent, Family Friend, etc.
Emergency Contact (Phone Number)*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact (Email Address)
example@example.com

Consent Form
Description

Elementary school students struggling with reading or math are individually partnered with a high school or university student volunteer. Assigned volunteers trained in fundamentals of reading and math (mentors) and students (buddies) meet multiple times per week either in person or online via Zoom. Designated volunteer coordinators are present at all sessions to assist in mentoring our mentors and buddies. A certified teacher and/or program supervisor is available during every session to help with instruction.

We follow a reading curriculum incorporating phonemic awareness, phonics, sight words, fluency and comprehension. Our math curriculum focuses on math numeracy, problem-solving, and critical thinking skills.

If participating in the online program, a free Zoom account can be made here: https://zoom.us/freesignup/.

Please email registration@learningbuddiesnetwork.com if you have any questions.
Please read and sign below:
Our mentoring program is designed to help children with their reading and math skills. It is not suitable for children with severe learning disabilities, severe ADHD or some children with autism, who learn better in ways that LBN does not provide. Please email registration@learningbuddiesnetwork.com if you have any questions about this policy.
Parent/guardian signature:*
By signing, I hereby acknowledge that I understand.
Date*

MonthDayYear
Date
For online programs only, we require that a guardian be present in the room for the entire duration of your child's program. Please ensure that you are in the room while your child participates in LBN's online program. Please write "N/A" in the 'Parent Signature' section below if your child is not part of our online program.
Parent/guardian signature:*
By signing, I hereby acknowledge that I understand.
Date*

MonthDayYear
Date
LBN would like the opportunity to take photos and videos of participants for our newsletters or for stories about LBN. Please indicate your agreement to us taking photos and / or videos of your child for these purposes. We will send you the Newsletter by email unless you opt-out below.
Do you consent to your child being included in photos and videos of sessions?*

YesNo
Would you like to receive our newsletter by email?*

YesNo
Would you like the newsletter translated (depends on volunteer translator availability)?*

YesNo
Parent/guardian signature:*
By signing, I hereby acknowledge that I understand.
Date*

MonthDayYear
Date

Other Children
Do you have another child you would like to enroll in LBN's programs?*

NoYes
Please note that each child needs a teacher to submit a referral form on their behalf.

The following information will not be used to register your 2nd child in LBN's programs, but to help with placement in the programs.
Child's Name*

First Name (Legal)First Name (Preferred)Last Name
Age of your child at the start of school in Fall 2025*
Number
Grade your child will be in during Fall 2025*
Number
Date of Birth*

MonthDayYear
Date
Please submit another full application form for your 2nd child.
Clicking the "Save" button will not submit your child's registration to Learning Buddies.

Please fill this form once for every child you wish to register in our program.

1. You must click the grey "Review Responses" button.

2. And then the green "Submit" button.

3. After Submitting a Form, you will automatically recieve an email confirmation. Please also check your email Spam folder.

4. Your child may be placed on a waitlist if the program you selected is full.

5. We will contact you by email and phone as soon as a spot becomes available.

6. For In-Person Programs: Please wait until we contact you before coming.

You can email us at: registration@learningbuddiesnetwork.com if you have any questions about registration.
Should be Empty:

Rows	1st Choice	2nd Choice	3rd Choice	4th Choice	Unavailable
Online - Mondays, Wednesdays, & Thursdays 10:00 - 10:45AM (Pacific Time)
Online - Mondays, Wednesdays, & Thursdays 5:30 - 6:15PM (Pacific Time)

Rows	First Choice	Second Choice	Third Choice	Fourth Choice	Unavailable
Online - Mondays & Wednesdays, 4:00 - 4:45PM (Pacific Time)
Online - Monday & Wednesday, 5:35 - 6:20 PM (Pacific Time)
Online - Tuesday & Thursday, 4:00 - 4:45 PM (Pacific Time)
Online - Tuesday & Thursday, 5:35 - 6:20 PM (Pacific Time)

LBN Buddy Registration Form

Child Information

Program Preference

In-Person Programs

Parent/Guardian Information

First Parent or Guardian

Second Parent or Guardian (If Applicable)

Child's Emergency Contact

Consent Form

Other Information

School

Our programs are best suited for children who already speak English and only need help with their reading and math skills.

Where did you hear about the Learning Buddies Network?

Support

Medical Form

Allergies and Dietary Restrictions

Demographic Questions

Other Children